X3.9 Clinical review and follow-up

There are no randomised clinical trials that have addressed the best method for follow-up (Sin 2002). It is recommended that the first review after a hospital admission should be by the GP and within seven days of discharge (Box 12). Chronic cough and sputum production is associated with an increased risk of further exacerbation (Burgel 2009) [evidence level III-2] and these patients may warrant closer monitoring. A decision about the requirement for specialist review should be made at the time of discharge. Follow-up care allows further discussion of self-management plans and future monitoring (Sin 2002).

Box 12: Follow-up – initial and subsequent
  • Assessment of the patient’s coping ability and strategies
  • Measurement of FEV1 and performance status
  • Reassessment of medication adherence and techniques with inhalation devices
  • Review of immunisation status (influenza and pneumococcal)
  • Assessment for long-term oxygen therapy (may require reference to specialist facility)
  • Consideration of referral for pulmonary rehabilitation
  • Assessment of risk of osteoporosis and management
  • Smoking cessation — counsel and/or refer
  • Assess nutritional status (frequent small meals reduce dyspnoea)