Luton & Dunstable Integrated Chronic Obstructive Pulmonary Disease (ICOPD)


The Bedfordshire Integrated COPD (ICOPD)

This is an innovative and ground-breaking service with two general hospitals working together to provide one 'unified' service for the patients of Bedfordshire. The service is provided by The Luton and Dunstable Hospital NHS Foundation Trust and Bedford Hospital NHS Trust, on behalf of NHS Bedfordshire.

The ICOPD Team includes consultants, respiratory nurse specialists, physiologists, and physiotherapists and provides the following services for patients who have known COPD:

  • Acute Respiratory Assessment Service (ARAS)
  • Early Supported Discharge (ESD)
  • Respiratory Nurse Intervention Clinics
  • Consultant Clinics
  • Physiotherapy Clinics
  • Pulmonary Rehabilitation
  • Home Oxygen Service

The key components of the ICOPD service are:

  • Acute Respiratory Assessment Service (ARAS)
  • Review of exacerbating COPD patients who are not responding to treatment

8.00am - 4.00pm Monday - Friday

Early Support Discharge Scheme (ESD)

Patients who are admitted to hospital and are identified as suitable for discharge home with support from the ICOPD team. They remain under the care of the hospital until fit for full discharge.

ICOPD will work as a multi-disciplinary team and refer to relevant agencies to enable safe discharge and help prevent re-admission.

Intervention Clinics

Run by respiratory nurse specialist / physiotherapist and supported by chest physicians and lung physiologists.

Following referral, the ICOPD team will ensure patients are seen in most appropriate setting (community or secondary care).

Pulmonary Rehabilitation

Suitable for patients with an MRC ≥3

  • Three venues are available:
    • Luton and Dunstable Hospital
    • Peter Newton Pavilion (Dunstable)
    • Stanbridge and Tilsworth Community Hall
  • Patients attend sessions twice a week, for seven weeks
  • Run by specialist physiotherapist and respiratory nurse specialists
  • Early post-exacerbation drop-in programs held at the L&D
  • Domiciliary Pulmonary Rehabilitation available

Consultant, respiratory nurse, pulmonary rehabilitation clinics are held as follows:

Houghton Regis Health Centre

  • Respiratory Nurse clinics - every Friday 09.00 - 13.00
  • Consultant clinics - alternate Thursday and Fridays 09.00 - 13.00
  • Physiology clinics -  alternate Fridays 09.00 - 13.00
  • Physiotherapy clinics - Thursdays 13.00 - 17.00

Salisbury House Surgery, Leighton Buzzard

  • Respiratory nurse clinics - every Monday 13.00 - 17.00
  • Physiotherapy clinics -  every Tuesday 09.00 - 13.00
  • Physiology clinics - alternate Mondays 13.00 - 17.00

Who to Refer

Intervention Clinics

  • Suitable for specialist assessment and diagnosis and interventions

Diagnostic uncertainty

  • Suspected severe COPD
  • Patient requests second opinion
  • Assessment /review of oxygen therapy
  • Assessment for nebuliser therapy
  • Assessment of oral corticosteroid therapy
  • A rapid decline in FEV1
  • Symptoms out of proportion to spirometry

Pulmonary Rehabilitation

  • Suitable for patients with an MRC ≥3
  • People who have had two or more hospital admissions in the last six months
  • People who have had two or more exacerbations in the last six months
  • People who  have an inability to cope with (two or more of the following):
    • Panic attacks
    • Reduced confidence
    • Increased anxiety
    • MRC dyspnoea >2

Who not to Refer

Patients with the following symptoms should be referred to the Department of Respiratory Medicine at Luton and Dunstable Hospital:

  • Onset of Cor Pulmonale (Ankle oedema, left parasternal heave, Tricuspid regurgitation)
  • Assessment for initiating oxygen therapy ( this is initiating not review so not repeated)
  • Bullous lung disease
  • Assessment for lung transplant/lung volume reduction
  • Age under 35, or family history of alpha1-antitrypsin deficiency
  • Frequent infection or haemoptysis
  • Suspected respiratory failure - symptoms such as profound shortness of breath, inability to complete sentences, peripheral or central cyanosis, increasing drowsiness, confusion, worsening peripheral oedema.
  • Any patients with documented acute asthma*
  • Patients with suggestions of lung conditions other than COPD*
  • Patients with TB*
  • Patients with interstitial lung disease*

*Note: These patients will require respiratory physician review

For Pulmonary Rehabilitation do not refer patients with:

  • Symptomatic cardiac failure
  • Hypertension (systolic > 240mg, diastolic>120mg
  • Uncontrolled/brittle asthma
  • Myocardial Infarction within six weeks
  • Severe/uncontrolled epilepsy
  • Unstable angina
  • Tachycardia (>120bpm at rest)

Last updated: 28/04/2014

Update due: 28/04/2015