NHG-Richtlijnen
NHG-Standaard
M26
5.1
april 2021
december 2022
R. Luchtwegen

Richtlijnen diagnostiek

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Evaluatie

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Richtlijnen beleid

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Voorlichting en niet-medicamenteuze adviezen

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Medicamenteuze behandeling

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Gebruik van ICS bij stap 2 of 3
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Monitoring

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Consultatie en verwijzing

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Beleid bij longaanval COPD

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Samenwerking en afstemming

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Achtergronden

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Begrippen

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COPD

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Ziektelast

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Persoonlijke behandeldoelen

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Restrictieve longaandoeningen

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Hyperinflatie

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Longaanval (exacerbatie) COPD

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Gelijktijdig astma en COPD (astma-COPD overlap of ACO)

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Epidemiologie

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Pathofysiologie

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Risicofactoren

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Roken

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Fijnstof

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Alfa-1-antitrypsinedeficiëntie

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Overige risicofactoren

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Oorzaak van longaanvallen

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Beloop en prognose van COPD

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Onderscheid en gelijktijdig bestaan van astma en COPD

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Richtlijnen diagnostiek

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Anamnese

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Voorgeschiedenis en comorbiditeit

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Spirometrie

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Referentiewaarden en interpretatie van spirometrie
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Randvoorwaarden voor spirometrie
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Aanwijzingen voor een mogelijke restrictieve afwijking bij spirometrie

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Aanpak
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Beeldvormend onderzoek

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Evaluatie

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Criteria voor de diagnose ‘COPD’

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Differentiaaldiagnose en comorbiditeit

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Gelijktijdig bestaan van astma en COPD (ACO)
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Overige aandoeningen
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Ziektelast

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Richtlijnen beleid

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Voorlichting en niet-medicamenteuze adviezen

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Aanpassen aan de ziekte (adaptatie)

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Begeleiding bij stoppen met roken

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Bewegen

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Fysiotherapie

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Zelfmanagement

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Individueel zorgplan
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Zelfmanagement bij longaanvallen
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Betrekken van gezinsleden

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E-health

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Werk

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Voedingstoestand

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Psychosociale gevolgen en psychiatrische problematiek

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Preventie van comorbiditeit

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Cardiovasculair risicomanagement
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Gebruik van bètablokkers
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Influenza- en pneumokokkenvaccinatie
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Fractuurpreventie
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Maagbescherming

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Ondersteunende informatie

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Medicamenteuze behandeling COPD

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Plaats van medicamenteuze behandeling van COPD

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Toedieningsvormen van inhalatiemedicatie

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Inhalatie-instructie

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Stappenplan inhalatiemedicatie

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Uitgangspunten
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Combinatiepreparaten
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Stap 1 Kortdurende luchtwegverwijding zo nodig
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Stap 2 Onderhoudsbehandeling met een langwerkende luchtwegverwijder
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Stap 3 Onderhoudsbehandeling met duotherapie LABA + LAMA
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Gebruik van inhalatiecorticosteroïden (ICS) in stap 2 of 3

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Indicatie
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Tripletherapie
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Stoppen met ICS
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Overige medicatie

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Orale corticosteroïden
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Antibiotica ter preventie van longaanvallen
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Acetylcysteïne
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Medicamenteuze behandelingsmogelijkheden in de tweede lijn

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Monitoring

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Doel en frequentie monitoring

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Monitoringsinstrumenten

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Spirometrie

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Consultatie en verwijzing

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Beleid bij longaanval COPD

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ABCDE instabiel

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ABCDE stabiel

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Richtlijnen diagnostiek
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Ernstige longaanval COPD
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Richtlijnen beleid bij ernstige longaanval
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Initiële behandeling tijdens consult of visite
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Beleid bij verbetering
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Verwijzing
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Richtlijnen beleid minder ernstige longaanval

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Behandeling
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Controle en follow-up na een longaanval

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Organisatie van de zorg

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Zorggroep

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Actieve opsporing

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Herevaluatie van de diagnose ‘COPD’

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Praktijkoverstijgende taken

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Aandachtspunten voor bespreking in de regio

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Samenwerking

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Zorgverleners

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Kaderhuisarts COPD (en astma)
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Praktijkondersteuner (poh)
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Longarts COPD
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Longverpleegkundige, physician assistant of verpleegkundig specialist voor COPD in de tweede lijn
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Apotheker
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Samenwerkingsafspraken

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Spirometrie en ander aanvullend onderzoek
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Hoofdbehandelaarschap
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Werkwijze van de huisarts bij consultatie of verwijzing naar een longarts
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Werkwijze van de longarts bij consultatie of verwijzing
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Werkwijze van de longarts bij terugverwijzing naar de huisarts
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Samenwerking bij longaanvallen
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Beleid in eindstadium COPD

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Tabel inhalatoren astma en COPD
Vernevelen
NHG-werkgroep:
Bischoff E, Bouma M, Broekhuizen L, Donkers J, Hallensleben C, De Jong J, Snoeck-Stroband J, In ’t Veen JC, Van Vugt S, Wagenaar M
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