Replacing the original National Institute for Health and Clinical Excellence (NICE) clinical guideline on COPD, published in 2004, this updated guideline makes a series of new recommendations based on the best evidence currently available. This partially updated guideline focuses particularly on diagnosis, severity classification, managing stable COPD and disease progression.
New recommendations have been added on diagnostic spirometry, clinical assessment and prognostic factors, and to the section on inhaled therapy which now incorporates the previously separate sections on inhaled bronchodilators, inhaled corticosteroids and inhaled combination therapy. Clear guidance is given on the sequencing and combination of inhaled therapies to achieve the best clinical and health economic outcomes based on persistence of symptoms and severity of airflow obstruction.
COPD is a broad term which covers several lung conditions including chronic bronchitis and emphysema and usually develops because of long-term damage to the lungs from breathing in a harmful substance such as cigarette smoke. It is a common condition which affects roughly 3 million people in the UK.
Symptoms include getting short of breath easily, having a cough that has lasted a long time, often coughing up phlegm or catarrh or a lot of coughing, breathlessness or wheezing during cold weather. Patients can also experience exacerbations, a sustained worsening of symptoms. These exacerbations are one of the most common causes of emergency hospital admission in the UK.
This guideline will help to provide the best possible care for people with COPD and is mainly aimed at primary and secondary healthcare professionals who have direct contact with patients with COPD, and make decisions about their care.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice at NICE said, “This new guideline, which has been developed by a range of experts, will help complement a wider Department of Health national strategy for COPD to identify the best ways to improve care and outcomes for those with COPD and to reduce the overall prevalence of the disease. In implementing this guideline, healthcare professionals can feel confident that they are providing people with COPD with the highest level of patient care.”
Michael Rudolf, Consultant Respiratory Physician at Ealing Hospital, London and Chair of the Guideline Development Group, said: “It is estimated that for every individual in the UK who has been identified as having COPD, there are probably at least two others who are suffering from the disease but who have not yet been diagnosed. Although the management of people with COPD has improved substantially over the last few years, there is still much more to be done, which is why the new updated NICE guideline contains recommendations specifically designed to address the issues of correct diagnosis and effective treatments.
“During the development of this update, all available evidence was thoroughly evaluated by a multidisciplinary guideline development group comprising health care professionals from primary and secondary care and patient representatives. I believe that the resulting recommendations will ensure that patients continue to receive the best possible care, both by improving identification of the condition and by increasing the choice of treatments based on the most up-to date clinical and cost effectiveness evidence.”
John O’Reilly, Consultant Physician, Aintree University Hospital and Guideline Development Group Clinical Advisor, said: “COPD can be a distressing condition and this guideline is set to make a real difference to patients’ quality of life. We hope this guideline will ensure that patients who have previously remained undiagnosed will now be diagnosed correctly using spirometry and be able to have access to the right treatment. Clinicians will now have clear guidance on the best sequence and combination of inhaled therapies based on persistence of symptoms and severity of airflow obstruction”
Measure post-bronchodilator spirometry to confirm the diagnosis of COPD.
Use the NICE definition of COPD based on the GOLD classification of severity of airflow obstruction.
Pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation.
Unless contraindicated, offer nicotine replacement therapy (NRT), varenicline or bupropion, as appropriate, to people who are planning to stop smoking combined with an appropriate support programme to optimise smoking quit rates for people with COPD.
Be aware of the potential risk of developing side-effects (including non-fatal pneumonia) in people with COPD treated with inhaled corticosteroids and be prepared to discuss with patients.
The clinical guideline ‘Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update)’ is available at www.nice.org.uk from Wednesday 23 June 2010.