Chronic obstructive pulmonary disease (COPD) - QOF indicator

COPD in QOF 2026/27

The COPD indicator covers ongoing review of patients on the register, with attention to exacerbations and breathlessness. For 2026/27, changes to the register are intended to correct inappropriate inclusion and capture patients receiving COPD care whose coding previously left them out.

Ongoing management

Why COPD is included

COPD encompasses lung conditions characterised by airway obstruction, including chronic bronchitis and emphysema. It is both common and disabling, and accounts for substantial use of unplanned healthcare. Annual flu vaccination offers the greatest benefit, followed, where relevant, by treatment for tobacco dependence. Pulmonary rehabilitation can improve quality of life and reduce exacerbations; inhaled bronchodilators and, for some patients, inhaled corticosteroids may also help.

GPs and the wider primary care team provide most COPD care, referring to secondary care as needed. The indicator is directed at care for people with symptomatic disease.

The 2026/27 register revision seeks to make inclusion more accurate: patients added in error should be removed, while those receiving COPD care without a COPD diagnosis code should be captured if previously excluded. Under the oversight of the national clinical director for respiratory disease, codes have been both withdrawn and introduced, including several relating to COPD care processes.

COPD0010 (based on NICE IND191)

Rationale and review requirements

Supported by NICE guidance, this indicator promotes documentation of exacerbation frequency and breathlessness assessment at annual COPD reviews. Knowing how often exacerbations occur informs individual care planning, helps identify triggers and supports efforts to prevent further episodes.

When assessing a patient at an annual review or considering a change in treatment, clinicians must document the following; a health-status tool may also be used:

• The number of exacerbations experienced.

• Breathlessness severity, assessed with the Medical Research Council (MRC) dyspnoea scale.

• Current health status, which can be assessed using a tool such as the COPD Assessment Test (CAT).

Evidence supports improved quality of life with inhaled treatment for some people with COPD. Patients also need instruction in using their inhaler, with subsequent reinforcement of that training. For anyone prescribed inhaled treatment, every review should include a face-to-face check of technique, or a video assessment if an in-person check is not possible.

The MRC dyspnoea scale quantifies breathlessness and is recommended for routine reviews. It can be found in table one of section 1.1, diagnosing COPD, in the NICE COPD guideline.

Reporting and verification

The requirements for this indicator are set out in its definition in the table above.