Monitor the symptoms and signs listed in table 1 to detect potential respiratory impairment, including breathlessness, increased respiratory rate, orthopnoea, shallow breathing, recurrent chest infections, weak cough, disturbed sleep, use of accessory muscles, daytime sleepiness, reduced chest expansion, poor concentration, confusion, hallucinations, morning headaches, fatigue, poor appetite, and inward abdominal movement during inspiration NICE NG42.
Assess respiratory function regularly, including measuring peak cough flow to evaluate cough strength NICE NG42.
Observe for physiological signs such as increased respiratory rate, use of accessory muscles, and reduced chest expansion on maximal inspiration NICE NG42.
Review sleep quality and patterns, noting non-refreshing sleep and nightmares NICE NG42.
Evaluate neurobehavioural cues and overall wellbeing, including signs of fatigue and cognitive changes NICE NG124.
Ensure ongoing clinical reviews to assess symptomatic and physiological changes, and adjust treatment accordingly NICE NG42.