What history questions should be asked during a COPD (Chronic Obstructive Pulmonary Disease) follow-up?

Key History Questions for COPD Follow-up

During a COPD follow-up visit, clinicians should systematically assess symptoms, exacerbation history, medication adherence, and functional status using validated tools to guide treatment decisions and improve patient outcomes. 1

Symptom Assessment

• Breathlessness assessment:

  • Use the Modified Medical Research Council (mMRC) Dyspnea Scale to quantify dyspnea severity (grades 0-4) 1
  • Ask about changes in breathlessness since last visit
  • Inquire about specific activities that trigger breathlessness
  • Determine if breathlessness is worse at rest, with exertion, or at night

• Cough and sputum evaluation:

  • Frequency of cough (daily, intermittent, nocturnal)
  • Timing of cough (morning predominance, throughout day)
  • Changes in sputum volume, color, or consistency (particularly increased purulence) 1
  • Presence of blood in sputum (hemoptysis) which may indicate complications or alternative diagnoses 1

Exacerbation History

• Number of exacerbations since last visit
• Severity of exacerbations (requiring antibiotics, oral corticosteroids, emergency visits, or hospitalizations) 1
• Duration of exacerbations
• Triggers identified for exacerbations
• Time since last exacerbation 1

Medication Assessment

• Adherence to prescribed medications (ask specifically about each medication)
• Proper inhaler technique (consider demonstration)
• Perceived effectiveness of current medications
• Side effects experienced from medications
• Use of rescue medications (frequency and recent changes in use pattern)
• Use of any over-the-counter medications or supplements

Functional Status and Quality of Life

• Impact of COPD on daily activities
• Exercise capacity and limitations
• Sleep quality and presence of nocturnal symptoms
• Changes in weight or appetite 1
• Employment status and ability to work 2
• Need for assistance with activities of daily living
• Use of special equipment to manage health problems 2

Risk Factor Exposure

• Current smoking status and exposure to secondhand smoke
• Occupational exposures to dusts, chemicals, or fumes
• Home environment exposures (heating fuels, air quality) 1
• Recent respiratory infections

Comorbidity Assessment

• Symptoms of comorbid conditions that may affect COPD management:
  • Cardiovascular disease (chest pain, edema, palpitations)
  • Depression and anxiety
  • Osteoporosis
  • Sleep apnea (snoring, daytime sleepiness) 1
  • Diabetes control

Pitfalls and Caveats

• Avoid focusing only on lung function: While spirometry is essential for diagnosis and classification, symptom burden and exacerbation history are better predictors of future risk and should guide treatment decisions 1

• Don't overlook subtle changes in symptoms: Patients often adapt to gradually worsening symptoms and may underreport their severity unless specifically questioned 1

• Consider using validated questionnaires: The COPD Assessment Test (CAT) or Clinical COPD Questionnaire can provide standardized assessment of symptoms beyond just dyspnea 1

• Remember to assess for depression and anxiety: These common comorbidities significantly impact quality of life but are often overlooked in COPD follow-up 1

• Evaluate for signs of cor pulmonale: Peripheral edema, jugular venous distention, and hepatomegaly may indicate development of right heart failure 1

By systematically addressing these key history elements during COPD follow-up visits, clinicians can better assess disease control, guide appropriate treatment adjustments, and improve patient outcomes.