HomeCOPD (Chronic Obstructive Pulmonary Disease) 
Predictive Treatment Tool 
(Initial rough draft - 12/2003)
Patient's Spirometry:   (FEV1 based on Post-bronchodilator)
Chronic symptoms present ? (e.g. Cough, sputum production, or dypsnea):
Clinical signs of right heart failure or respiratory failure:
Frequent exacerbations:
Please check any that apply (if present) - acute changes:
 Increased dyspnea   |  Increased sputum volume   | Increased sputum purulence
Current Medications (Please check all that apply):  
Ipratropium: | Short-acting Beta-2 agonist (e.g. albuterol):   |  Theophylline (IV or po):  | 
Long-acting Beta-2 agonist (e.g. Salmeterol): |   Corticosteroid (systemic):   |  Corticosteroid (inhaler):
Determine if a patient meets criteria for the following interventions: 
General Guidelines: 
Respir Care. 2001 Aug;46(8):798-825. 
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: National Heart, Lung, and Blood Institute and World Health Organization Global Initiative for Chronic Obstructive Lung Disease (GOLD): executive summary.   Pauwels RA, Buist AS, Ma P, Jenkins CR, Hurd SS; GOLD Scientific Committee.