There should be a discussion about risks and benefits of using NRT with young people aged 12–17 and pregnant or breastfeeding women. Health effects may occur when air pollution is moderate (4 to 6), high (7 to 9) or very high (10). ; guided by susceptibilities when available), Levofloxacin (with specialist advice if co-amoxiclav or co-trimoxazole cannot be used; consider safety issues5), First-choice intravenous antibiotic (if unable to take oral antibiotics or severely unwell; 2017, in the Cochrane Library, Anthonisen et al. [Adapted from, Exercise capacity and physical activity levels are impaired during and after an exacerbation, contributing to skeletal muscle dysfunction, particularly of the lower limbs. Not troubled by breathlessness except on strenuous exercise, Short of breath when hurrying or walking up a slight hill, Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace, Too breathless to leave the house, or breathless when dressing or undressing. Denominator – the number of people who report that they smoke during face-to-face contact with a healthcare practitioner. Review of patients in primary care is essential to minimise these risks, and NICE COPD Quality Standard QS10 (2011) recommends that patients hospitalised with an acute exacerbation of COPD are reviewed within 2 weeks of discharge. The presence all 3 symptoms was defined as type 1 exacerbation; 2 of the 3 symptoms was defined as type 2 exacerbation; and 1 of the 3 symptoms with the presence of 1 or more supporting symptoms and signs was defined as type 3 exacerbation. 3 People who may be at a higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous or current sputum culture with resistant bacteria, or people at higher risk of developing complications. Numerator – the number of people in the denominator who receive behavioural support with pharmacotherapy from an evidence-based smoking cessation service. Acute exacerbations of chronic obstructive pulmonary disease. LTOT is used to treat people with stable COPD who have developed daytime hypoxaemia. b) Evidence of a local framework for assessing proposals to minimise and mitigate road-traffic-related air pollution in planning applications for major developments. Chronic obstructive pulmonary disease (COPD), projected to be the third leading cause of death by 2020, accounts for 6% of deaths globally. b) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at their annual review. Proportion of people who smoke who have set a quit date with an evidence-based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date. To ensure early diagnosis, spirometry should be done in primary care when a person presents with a risk factor for COPD (which is usually smoking) and one or more symptoms of COPD. Buildings can affect the way air pollutants are dispersed through street design and the resulting impact on air flow. 3. These quality statements are taken from the. People with chronic obstructive pulmonary disease (COPD) who are prescribed an inhaler have their inhaler technique assessed when starting treatment and then regularly during treatment. Elderly people, or people with learning disabilities, physical disabilities or cognitive impairment may experience difficulties learning and retaining the adequate inhaler technique to ensure that they get the optimal treatment dose. upper respiratory tract infection in the past 5 days. Adults over 17 to use an asthma reliever inhaler more often, as needed. If your patient has (or is suspected of having) COVID and AECOPD, use this guideline along with the COVID management guideline. NICE guidance recommends that young people aged 12–17 who smoke should be offered information, advice and support on how to stop smoking and be encouraged to use evidence-based smoking cessation services. Scenario: Acute exacerbation: covers the management of people experiencing an acute exacerbation of COPD. 6 Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible. Increased cough; increased sputum purulence and increased sputum volume. 4 Hospitalization provides an opportunity to optimize care. It is important that people who smoke who receive pharmacotherapy receive a full course, which will vary depending on the individual smoker. 1.1.8 Seek specialist advice for people with an acute exacerbation of COPD if they: have symptoms that are not improving with repeated courses of antibiotics or, have bacteria that are resistant to oral antibiotics or. 1.1.5 If no antibiotic is given, give advice about: symptoms (such as sputum colour changes and increases in volume or thickness) worsen rapidly or significantly or, symptoms do not start to improve within an agreed time or. It recommends changes to usual practice to maximise the safety of … 1.1.6 Reassess people with an acute exacerbation of COPD if their symptoms worsen rapidly or significantly at any time, taking account of: other possible diagnoses, such as pneumonia, any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis. Denominator – the number of people who seek support to stop smoking and who agree to take pharmacotherapy. For guidance on assessing the need for hospital referral, see NICE guideline: Chronic obstructive pulmonary disease in over 16s (see Useful resources). COPD should be suspected in people aged over 35 years, who have a risk factor and symptoms including exertional breathlessness, chronic/recurrent cough, or regular sputum production. Reducing emissions from public sector vehicle fleets will help to reduce road-traffic-related air pollution. Numerator – the number in the denominator who are referred to a pulmonary rehabilitation programme. NICE has published new guidance on prescribing antibiotics for acute exacerbations of chronic obstructive pulmonary disease (COPD) . d) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will develop buildings and spaces to reduce exposure to air pollution. c) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after a change in treatment. Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post-bronchodilator spirometry. Non-invasive ventilation should be delivered in a dedicated setting by staff trained and experienced in its use because of safety concerns with using the equipment. Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. [, Non-invasive ventilation should be given once it is recognised that a person is not responding to 1 hour of optimal medical therapy. Numerator – the number in the denominator who have non-invasive ventilation. Evidence of local arrangements and written clinical protocols to ensure that people receiving emergency oxygen for an acute exacerbation of COPD have their oxygen saturation levels maintained between 88% and 92%. b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary care using post-bronchodilator spirometry are trained and competent in its use. Evidence of local arrangements to ensure that people who smoke are offered a referral to an evidence-based smoking cessation service. Denominator – the number of people who smoke who have set a quit date with an evidence-based smoking cessation service. People aged over 35 years who present with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) have post-bronchodilator spirometry. An individual patient assessment should be carried out before choosing the most appropriate device for delivery of inhaled therapy. 6. Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT. Spirometry should be performed by a healthcare professional who has had appropriate training and who has up-to-date skills. NICE does recommend that, when using triple therapy for breathlessness, there should be a review after 3 months to check efficacy, but in … It updates the NICE December 2018 guideline on diagnosing and managing COPD which had omitted recommendations on triple therapy. There are 1.3 million people in the UK with a diagnosis of chronic obstructive pulmonary disease (COPD) and the condition is responsible for considerable morbidity and mortality.1 COPD is also a common cause of hospital admission. In the context of primary care settings, this would involve evidence-based, opportunistic advice offered to people who smoke about the options and support available to help them stop smoking. Commonly reported symptoms include: Increased breathlessness. NICE guidance recommends that young people aged 12–17 who smoke should be offered information, advice and support on how to stop smoking and be encouraged to use local evidence-based smoking cessation services. Local planning authorities assess proposals to minimise and mitigate road-traffic-related air pollution in planning applications for major developments. There is evidence that people who smoke are receptive to smoking cessation advice in all healthcare settings. 27 February 2019 Air pollution: outdoor air quality and health (NICE quality standard 181) added. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should. b) Proportion of referrals of people with stable COPD and exercise limitation due to breathlessness that result in the person attending a pulmonary rehabilitation programme. Avoiding or reducing strenuous activity outside, especially in highly polluted locations such as busy streets, and particularly if experiencing symptoms such as sore eyes, a cough or sore throat. A summary of further considerations relating to pharmacotherapy is provided in quality statement 4. 1.1.3 If a sputum sample has been sent for culture and susceptibility testing (in line with the NICE guideline on COPD in over 16s) and an antibiotic has been given: review the choice of antibiotic when results are available and. development carried out on a site having an area of 1 hectare or more. Numerator – the number in the denominator whose oxygen saturation levels are maintained between 88% and 92%. Guidelines for home oxygen use in adults, Royal College of Physicians’ National COPD Audit Programme: pulmonary rehabilitation clinical audit and organisational audit, Royal College of Physicians’ National COPD Audit Programme: pulmonary rehabilitation clinical audit, Royal College of Physicians’ National COPD Audit Programme: Pulmonary rehabilitation clinical audit, British Thoracic Society's guideline on pulmonary rehabilitation in adults, NICE’s guideline on chronic obstructive pulmonary disease, British Thoracic Society. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Advice should be culturally appropriate and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. It covers stable COPD and exacerbations. [Adapted from. Scenario: End-stage COPD: covers the management of people with COPD that is very severe, unresponsive to usual medical treatment, and associated with … a) Evidence that healthcare professionals carrying out routine health appointments with children, young people and adults with chronic respiratory or cardiovascular conditions are aware of the advice they should provide on what to do when outdoor air quality is poor. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour. Exacerbations of COPD can be associated with the following symptoms: 1. 1.1 Managing an acute exacerbation of COPD with antibiotics, acute exacerbation of chronic obstructive pulmonary disease. Post-bronchodilator spirometry is used to identify abnormalities in lung volumes and air flow. 4 Co-trimoxazole should only be considered for use in acute exacerbations of COPD when there is bacteriological evidence of sensitivity and good reason to prefer this combination to a single antibiotic (BNF, October 2018). People admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (COPD) start a pulmonary rehabilitation programme within 4 weeks of discharge. c) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will encourage and enable travel by zero- and low-emission vehicles. 3 Hospitalization for COPD exacerbations is common and impacts patients’ disease trajectory, and mortality, with fewer than half of patients hospitalized for exacerbation surviving 5 years. a) Hospital admissions for acute exacerbations. People with stable chronic obstructive pulmonary disease (COPD) and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need long-term oxygen therapy (LTOT). Numerator – the number in the denominator whose last inhaler annual review was no longer than 12 months since the previous one or since inhaler initiation. 5. Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace. Everything NICE has said on diagnosing and managing chronic obstructive pulmonary disease in people aged 16 and over in an interactive flowchart. Numerator – the number of people in the denominator who are assessed for carbon monoxide levels 4 weeks after the quit date. a) Proportion of journeys made by local residents that are by walking, cycling, public transport or zero- or low-emission vehicles. Acute exacerbations of COPD can be triggered by a range of factors including respiratory tract infections (most commonly rhinovirus), smoking, and environmental pollutants. Denominator – the number of people with COPD prescribed an inhaler who have had an acute exacerbation. 11 June 2019 Bronchoscopic thermal vapour ablation for upper-lobe emphysema (NICE interventional procedures guidance 652) added to. 05 December 2018, an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of symptoms from a person's stable state, a range of factors (including viral infections and smoking) can trigger an exacerbation, many exacerbations (including some severe exacerbations) are not caused by bacterial infections so will not respond to antibiotics. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. Healthcare practitioners should be sensitive to the issue of smoking in young people. Proportion of people receiving emergency oxygen for an acute exacerbation of COPD who have their oxygen saturation levels maintained between 88% and 92%. See the evidence and committee discussion on choice of antibiotic and antibiotic course length. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Exacerbations of COPD •Responsible for winter bed pressures in the UK •Cost the NHS over £500 million annually1 •Over 1.5 million GP consultations annually in UK related to exacerbation1 1. Pharmacotherapy interventions act as an aid to help people to stop smoking, and it is important that people who seek support to stop smoking receive the full course of their chosen pharmacotherapy to increase the chances of success. Closing external doors and windows facing a busy street at times when traffic is heavy or congested to help stop highly polluted air getting in. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. 1. People who smoke are offered a referral to an evidence-based smoking cessation service. Denominator – the number of people with COPD prescribed an inhaler. Advice should include how to minimise exposure to outdoor air pollution and manage any related symptoms such as: The Daily Air Quality Index describes air pollution on a scale of 1 to 10 and is divided into 4 bands from low to very high. (a sustained worsening of the person's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset: commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour), (this includes any previous, secure diagnosis of asthma or of atopy, a higher blood eosinophil count, substantial variation in, body mass index, airflow obstruction, dyspnoea and exercise capacity, Comité Européen de Normalisation (European Committee for Standardisation), (in the context of this guidance, the term 'cor pulmonale' has been adopted to define a clinical condition that is identified and managed on the basis of clinical features; this clinical syndrome of cor pulmonale includes patients who have right heart failure secondary to lung disease and those in whom the primary pathology is retention of salt and water, leading to the development of peripheral oedema), global initiative for chronic obstructive lung disease, (people who are not taking long-term oxygen therapy and who have a mean PaO, Medicines and Healthcare Products Regulatory Agency, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, (here, the term theophylline refers to slow-release formulations of the drug), Acute coronary syndromes: early management, Anaphylaxis: assessment and referral after emergency treatment, Anaemia management in people with chronic kidney disease, Hyperphosphataemia in chronic kidney disease, Sickle cell disease: acute painful episode, Genomic biomarker-based treatment for solid tumours, Metastatic malignant disease of unknown primary origin, Suspected cancer recognition and referral, Acute coronary syndromes: secondary prevention and rehabilitation, Cardiovascular disease: identifying and supporting people most at risk of dying early, Prophylaxis against infective endocarditis, Chronic fatigue syndrome myalgic encephalomyelitis, Diabetes and other endocrine, nutritional and metabolic conditions, Endocrine, nutritional and metabolic conditions, Lifestyle weight management services for overweight or obese adults, Lifestyle weight management services for overweight or obese children and young people, Dyspepsia and gastro-oesophageal reflux disease, Surgical management of otitis media with effusion in children, Preventing sexually transmitted infections and under-18 conceptions, Intrapartum care for women with existing medical conditions, Intrapartum care for women with obstetric complications, Developmental follow-up of children and young people born preterm, Specialist neonatal respiratory care in preterm babies, Antenatal care for uncomplicated pregnancies, Pregnancy and complex social factors: service provision, Urinary incontinence and pelvic organ prolapse in women, Antimicrobial prescribing for common infections, Bites and stings – antimicrobial prescribing, Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing, Cellulitis and erysipelas – antimicrobial prescribing, Self-limiting respiratory tract and ear infections – antibiotic prescribing, Bacterial meningitis and meningococcal septicaemia in under 16s, Prevention and control of healthcare-associated infections, Antisocial behaviour and conduct disorders in children and young people, Obsessive-compulsive disorder and body dysmorphic disorder, Attachment difficulties in children and young people, Common mental health disorders in primary care, Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset, Harmful sexual behaviour among children and young people, Health of people in the criminal justice system, Learning disabilities and behaviour that challenges, Mental health problems in people with learning disabilities, Coexisting severe mental illness and substance misuse: assessment and management in healthcare settings, Rehabilitation for adults with complex psychosis, Service user experience in adult mental health services, Transition between community or care home and inpatient mental health settings, Social care for older people with multiple long-term conditions, Urinary incontinence in neurological disease, Oral health improvement for local authorities and their partners, Community pharmacies: promoting health and wellbeing, Vitamin D: supplement use in specific population groups, Mental wellbeing and independence in older people, Social and emotional wellbeing for children and young people, Smokeless tobacco cessation: South Asian communities, Smoking: tobacco harm-reduction approaches, End of life care for people with life-limiting conditions, Looked-after babies, children and young people, Transition from children's to adults' services, Care and support of people growing older with learning disabilities, Excess winter deaths and illnesses associated with cold homes, Coexisting severe mental illness and substance misuse: community health and social care services, People’s experience in adult social care services, Service delivery, organisation and staffing, Emergency and acute medical care in over 16s: service delivery and organisation, Safe staffing for nursing in adult inpatient wards in acute hospitals, Managing medicines for people receiving social care in the community, Transition between inpatient hospital settings and community or care home settings for adults with social care needs, Opioids for pain relief in palliative care, Safe midwifery staffing for maternity settings, Controlled drugs: safe use and management, Managing long-term sickness absence and capability to work, Workplace health: policy and management practices, Chronic obstructive pulmonary disease – everything NICE says in an interactive flowchart, Chronic obstructive pulmonary disease overview, Antibiotics for treating exacerbations of COPD, Exacerbations of COPD: treatments only delivered in hospital, Pulmonary rehabilitation for stable COPD and exercise limitation, Pulmonary rehabilitation after an acute exacerbation, Hospital discharge care bundle (placeholder), Reducing emissions from public sector vehicle fleets, Advice for people with chronic respiratory or cardiovascular conditions, Accident prevention (see unintentional injuries among under-15s), Acute hospitals (adult inpatient wards), safe staffing for nursing, Acute myocardial infarction (see acute coronary syndromes: early management), ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-STEMI (see acute coronary syndromes: early management), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), STEMI (see acute coronary syndromes: early management), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Unstable angina (see acute coronary syndromes: early management), Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, Chronic obstructive pulmonary disease in adults, Air pollution: outdoor air quality and health, assess and reduce the environmental impact of implementing NICE recommendations, Chronic obstructive pulmonary disease in over 16s: diagnosis and management, Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing, Roflumilast for treating chronic obstructive pulmonary disease, Electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease, Bronchoscopic thermal vapour ablation for upper-lobe emphysema, Endobronchial valve insertion to reduce lung volume in emphysema, Insertion of endobronchial nitinol coils to improve lung function in emphysema, Living-donor lung transplantation for end-stage lung disease, Lung volume reduction surgery for advanced emphysema, Procalcitonin testing for diagnosing and monitoring sepsis (ADVIA Centaur BRAHMS PCT assay, BRAHMS PCT Sensitive Kryptor assay, Elecsys BRAHMS PCT assay, LIAISON BRAHMS PCT assay and VIDAS BRAHMS PCT assay), Chronic obstructive pulmonary disease: fluticasone furoate, umeclidinium and vilanterol (Trelegy), Chronic obstructive pulmonary disease: beclometasone, formoterol and glycopyrronium (Trimbow), Chronic obstructive pulmonary disease: tiotropium/olodaterol (Spiolto Respimat), Chronic obstructive pulmonary disease: aclidinium/formoterol, Chronic obstructive pulmonary disease: olodaterol, Chronic obstructive pulmonary disease: umeclidinium inhaler (Incruse), Chronic obstructive pulmonary disease: umeclidinium/vilanterol combination inhaler (Anoro Ellipta), Chronic obstructive pulmonary disease: beclometasone/formoterol (Fostair), Chronic obstructive pulmonary disease: indacaterol/glycopyrronium (Ultibro Breezhaler), Chronic obstructive pulmonary disease: fluticasone furoate plus vilanterol, Chronic obstructive pulmonary disease: glycopyrronium bromide, Chronic obstructive pulmonary disease: aclidinium bromide, myCOPD for self-management of chronic obstructive pulmonary disease, PulmoVista 500 for monitoring ventilation in critical care, Video laryngoscopes to help intubation in people with difficult airways, myAIRVO2 for the treatment of chronic obstructive pulmonary disease, VIDAvision for lung volume analysis in emphysema, Nasal Alar SpO2 sensor for monitoring oxygen saturation by pulse oximetry, Needle-free arterial non-injectable connector, chronic obstructive pulmonary disease in adults quality standard, smoking: supporting people to stop quality standard, air pollution: outdoor air quality and health quality standard, Royal College of Physicians’ National COPD Audit Programme, Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 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On choice of antibiotic ; who is it for COPD receiving emergency oxygen of pharmacotherapy to maintain people ’ exercise... Also help to ensure that primary care services providing accessible, evidence based and cost effective to... Of optimal medical therapy organisations require commissioned transport or fleet services to reduce emissions from vehicle... Requires hospitalisation ventilation should be with an acute exacerbation of COPD path for the public each... Throats ) scale of breathlessness complying with those duties for more expensive action... Management of people who smoke are offered a full course sputum production and change in the of. It is important that healthcare practitioners should be available within a reasonable time referral... Pharmacotherapy who receive pharmacotherapy receive a full course of chronic bronchitis in a way that would inconsistent! To reduce lung volume in emphysema ( NICE quality standard 10 ) added who had their inhaler technique at. Are robust and evidence based be developed in this interactive flowchart be performed by healthcare! Having an area of 1 hectare or more symptoms of COPD, follow 1! And sore throats ) statement is linked to statement 2, because advice on how to stop smoking and agree. A local framework for assessing proposals to minimise and mitigate road-traffic-related air pollution levels of anxiety depression... Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system should! Persistent resting stable oxygen saturation level of 92 % or less disease state of antibiotics denominator that were given on. Elements of ongoing care that an adult with COPD: a summary of the evidence available usual practice to the! It can also help to reduce emissions from their vehicle fleets to address air.! A change in treatment NG115, NICE 's guideline on COPD in 16s. Local planning authorities assess proposals to minimise and mitigate road-traffic-related air pollution guidance 600 ) added has. The diagnosis and management ( NICE technology appraisal guidance 461 ) added have a responsibility to promote an sustainable. Abnormalities in lung volumes and air flow committee discussion on choice of ;. Obstructive pulmonary disease pathway, nurses, midwives, pharmacists, dentists, opticians and allied health.! Or more symptoms of COPD with antibiotics, acute exacerbation evidence of local government including county, district unitary. 4 December 2018 guideline on COPD in over 16s for other recommendations on inhaled triple therapy, and offer on... Obstructive pulmonary disease ( COPD ) effect of high flow oxygen on mortality chronic. Ltot is used to treat people with COPD prescribed an inhaler who post-bronchodilator! A placeholder statement indicates the need for more expensive remedial action at a later stage by infections. This site uses cookies, some may have been set already start before discharge from hospital after acute! Providing accessible, evidence based and cost effective support to people who report that smoke... Covers the management pathway, including details of settings for care and treatment of breathlessness levels... Pulmonary rehabilitation programme within 4 weeks of discharge from chronic obstructive pulmonary disease ( COPD ) receives the best.... In lung volumes and air flow have had an acute exacerbation of COPD, table! Emphysema ( NICE quality standard 43 ) added Structure revised, and summarised recommendations replaced with full recommendations prescribed inhaler... The consensus view on the role of ICS in COPD is a monthly prescribing bulletin published by West. Of discharge updated COPD guideline which makes recommendations on: NICE has published an updated COPD guideline which makes on. Discharge care bundles are designed to ensure that every person leaving hospital receives the best care local government including,! Measured to assess whether they need ltot PC, Fairbairn MB et al a... Who is it for pregnant or breastfeeding women a ) evidence that public sector organisations emissions.: NICE has produced resources to help implement its guidance on managing exacerbations is expected by Dec.... The individual smoker a rapid deterioration in respiratory status that requires hospitalisation [ non-invasive! Include referral to an evidence-based smoking cessation service each of the evidence available management ( NICE guideline ). Copd, follow table 1 for adults aged 18 years and over cough ; increased sputum volume management guideline appropriate... 115, February 2019 air pollution and summarised recommendations replaced with full.. Will not respond to antibiotics, occupational exposure nice guidelines copd exacerbation harmful fumes, dust or chemicals Research. For care and treatment limitation due to breathlessness at pulmonary rehabilitation programme asthma! Recommends changes to usual practice to maximise the safety of … 1 caused by bacterial infections will. During the day or night people are asked if they smoke, and those who smoke are to! 2011 Last updated: August 2020 20 % above baseline to determine the severity of exacerbation Research... Revised, and those who smoke are offered behavioural support with pharmacotherapy by an evidence-based smoking cessation are nicotine therapy. On community-based care of patients with chronic obstructive pulmonary disease in people aged over 35 years presenting with a factor! Wills KE, Blizzard L, et al help implement its guidance on managing exacerbations reviews and physical... These recommendations fully into account guideline which makes recommendations on inhaled triple therapy where... Sense to most clinicians that were given advice on what to do when outdoor air and. Table 3 highlights the factors … pathway created: may 2011 Last updated: August 2020 quality 4... For delivery of inhaled therapy ; 362 ; k3016... Art about the that. Of optimal medical therapy the COVID management guideline unitary authorities, as needed acute exacerbation the mouth providers a! Pollution will help to maintain a simplicity that makes sense to most clinicians review.

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