Authors' objectives:

This report provides guidelines on the management of chronic obstructive pulmonary disease in adults in primary and secondary care.

Authors' recommendations: Key priorities for implementation: The following recommendations have been identified as priorities for implementation. Diagnose COPD - A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze. The presence of airflow obstruction should be confirmed by performing spirometry. - All health professionals managing patients with COPD should have access to spirometry and be competent in the interpretation of the results. Stop smoking - Encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity. Effective inhaled therapy - Long-acting inhaled bronchodilators (beta2-agonists and/or anticholinergics) should be used to control symptoms and improve exercise capacity in patients who continue to experience problems despite the use of short-acting drugs. - Inhaled corticosteroids should be added to long-acting bronchodilators to decrease exacerbation frequency in patients with an FEV1 less than or equal to 50% predicted who have had two or more exacerbations requiring treatment with antibiotics or oral corticosteroids in a 12-month period. Pulmonary rehabilitation for all who need it - Pulmonary rehabilitation should be made available to all appropriate patients with COPD. Use non-invasive ventilation - Non-invasive ventilation (NIV) should be used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff trained in its application, experienced in its use and aware of its limitations. - When patients are started on NIV, there should be a clear plan covering what to do in the event of deterioration and ceilings of therapy should be agreed. Manage exacerbations - The frequency of exacerbations should be reduced by appropriate use of inhaled corticosteroids and bronchodilators, and vaccinations. The impact of exacerbations should be minimised by: - giving self-management advice on responding promptly to the symptoms of an exacerbation - starting appropriate treatment with oral corticosteroids and/or antibiotics - use of non-invasive ventilation when indicated - use of hospital-at-home or assisted-discharge schemes. Multidisciplinary working - COPD care should be delivered by a multidisciplinary team.

Authors' methods: Clinical guideline

Project Status: Completed

Year Published: 2004

URL for published report: http://publications.nice.org.uk/chronic-obstructive-pulmonary-disease-management-of-chronic-obstructive-pulmonary-disease-in-adults-cg12

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: National Institute for Clinical Excellence

Contact Address: MidCity Place, 71 High Holborn, London WC1V 6NA, UK. Tel: +44 020 7067 5800; Fax: +44 020 7067 5801

Contact Name: nice@nice.nhs.uk

Contact Email: nice@nice.nhs.uk

Copyright: <p>National Institute for Clinical Excellence (NICE)</p>