Risk Stratification
The National Institute of Health and Clinical Excellence (NICE) has published guidance on factors that should be considered when determining most appropriate place for the treatment of patients with exacerbations of COPD (Table 4).
Table 4: NICE Guideline. Factors to Consider when deciding where to treat the patient [4]
| Factor | Treat at home | Treat in hospital |
| Able to cope at home | Yes | No |
| Breathlessness | Mild | Severe |
| General condition | Good | Poor / deteriorating |
| Level of activity | Good | Poor / confined to bed |
| Cyanosis | No | Yes |
| Worsening peripheral oedema | No | Yes |
| Level of consciousness | Normal | Impaired |
| Already on long term oxygen | No | Yes |
| Social circumstances | Good | Living alone / not coping |
| Acute confusion | No | Yes |
| Rapid rate of onset | No | Yes |
| Significant comorbidity | No | Yes |
| Sats < 90% | No | Yes |
| CXR changes | No | Yes |
| Arterial pH | > 7.35 | < 7.35 |
| Arterial PaO2 | > 7 kPa | < 7 kPa |
NICE have also classified severity of airflow obstruction related to spirometry measurements (Table 5).
| Post bronchodilator FEV1 / FVC ratio | FEV1 % predicted | Severity of disease |
| <0.7 | > 80% | Stage 1 – Mild |
| <0.7 | 50-79% | Stage 2 – Moderate |
| <0.7 | 30-49% | Stage 3 – Severe |
| <0.7 | < 30% | Stage 4 – Very Severe |