Monitoring
Assess
Suitability for Discharge
Prior to discharge from the hospital, check if the patient is able
to use long-acting either beta2-agonists and/or anticholinergics with
or without ICS and if inhaled beta2-agonist is needed every 4 hours
or less frequently.
Also check if the patient is already able to walk across the room
(if previously ambulatory), able to eat and sleep without frequent
interruptions due to breathing difficulty, is clinically stable for 12-24 hours,
and his/her ABG results are stable for 12-24 hours.
Prior to discharge, make sure that the home care
arrangements (eg oxygen delivery) are in place. It is also essential that the patient
and caregiver adequately understand the correct medication use, and that the patient,
family, and physician are confident that the patient can manage well.
Arrange
for Follow-up Assessments
A follow-up assessment must be carried out within 4-12 weeks
following discharge from the hospital for exacerbations. This is to check the
patient’s ability to cope in his environment, measure FEV1, check
inhaler technique, and check understanding and ability to follow the treatment
regimen.
During follow-up, one may also assess the need for long-term oxygen
therapy and/or home nebulizer for patients with very severe COPD.
It is also important to check for the status of
comorbidities (eg cardiovascular diseases, lung cancer, osteoporosis,
depression or anxiety, diabetes mellitus, metabolic syndrome, GERD, obstructive
sleep apnea, bronchiectasis, infections).
Remote consultations or follow-ups may be considered during the COVID-19
pandemic if the patient is able to understand the process and can provide clear
information, there is a regular follow-up, the medical records and laboratory
tests are accessible to the healthcare provider, and that access to medication
is possible.