Prior to QMR

• Review the Quarterly Medication Review Deprescribing Focus – Optimizing COPD Treatment
• Review their symptoms, the occurrence of acute exacerbations of COPD (AECOPD) in the past 12 month, and their use of short-acting bronchodilators (e.g. salbutamol) in the past 3 months to estimate the effectiveness of their current COPD management.
• If the resident’s respiratory diagnosis isn’t clear, consider consulting respirology or respiratory therapy (RT), as available

During QMR

• Assess the effectiveness of their current COPD management:
  • Has therapy with bronchodilators been optimized?
  • If currently on an ICS containing regimen, assess if treatment with an ICS is warranted or if a stepwise withdrawal of the ICS can be attempted.
  • Is the resident able to effectively use the current inhaler device? If not, consider switching to an alternate device/medication in the same class or consult RT, if available, to assess and make device recommendations. Refer to the attached COPD treatment resources.
  • Reassess any therapy changes made in the past 6 months for bronchodilators and 12 months for ICS combinations.
  • Dependent on the resident’s symptoms, lung function, and risk of exacerbations, consider if a treatment step up or step down is warranted. Refer to Figure 1 on page 2 for guidance.

• Assess the resident’s future risk of AECOPD
• Assess if the resident is experiencing any side effects (e.g. thrush, pneumonia in the past year, throat irritation, dry mouth).
• Identify residents who smoke tobacco or medical cannabis
  • Smoking cessation can help slow lung function decline, decrease symptoms, reduce the risk of pneumonia, reduce the frequency/severity of AECOPD and hospitalizations, and prolong survival time of patients. Refer to regional smoking cessation or tobacco use resources.