National Institute for Health and Clinical Excellence Updates COPD Guidance

The National Institute for Health and Clinical Excellence (NICE) has updated its guidance on diagnosing and managing adult patients with chronic obstructive pulmonary disease (COPD), replacing its original clinical guidance which was published in 2004.

This updated guidance aims to improve the care of COPD patients in primary and secondary care. It is aimed mainly at primary and secondary healthcare professionals who have direct contact with patients with COPD and who make decisions about their care.

Updates to the previous guidelines focus primarily on diagnosis, classification, management of stable COPD and disease progression. Specifically, recommendations have been added on diagnostic spirometry, clinical assessment, prognostic factors and inhaled therapy.

Included is clear guidance 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.

Key clinical updates in the guideline include:

• The use of the NICE definition of COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of severity of airflow obstruction.
• Pulmonary rehabilitation for all appropriate COPD patients, including those who have recently been hospitalized for an acute exacerbation.
• Measure of post-bronchodilator spirometry to confirm the diagnosis of COPD.
• Unless contraindicated, the offer of nicotine replacement therapy (NRT) using varenicline or bupropion, as appropriate, to people who are planning to stop smoking. This combined with an appropriate support program to optimize smoking quit rates.
• Awareness of the potential risk of developing side effects (including nonfatal pneumonia) in people with COPD who are treated with inhaled corticosteroids.