We found no new evidence that affects the recommendations in this guideline. [2004]. [2018], 1.2.92 Refer people with COPD for an assessment for bullectomy if they are breathless and a CT scan shows a bulla occupying at least one third of the hemithorax. NICE COPD guidance for diagnosis, management, and antimicrobial prescribing for acute exacerbations. Consider LABA+ICS for people who: have asthmatic features/features suggesting steroid responsiveness and, 1.2.13 Last updated May 2019. People who are having long-term oxygen therapy should be reviewed at least once per year by healthcare professionals familiar with long-term oxygen therapy. [2004], 1.1.19 Untreated COPD and asthma are frequently distinguishable on the basis of history (and examination) in people presenting for the first time. [2018]. [2004], 1.2.23 Only prescribe inhalers after people have been trained to use them and can demonstrate satisfactory technique. [2018], 1.2.50 Review prophylactic azithromycin after the first 3 months, and then at least every 6 months. At diagnosis and at each review appointment, offer people with COPD and their family members or carers (as appropriate): written information about their condition, opportunities for discussion with a healthcare professional who has experience in caring for people with COPD. [2004]. Before starting azithromycin, ensure the person has had: an electrocardiogram (ECG) to rule out prolonged QT interval and, 1.2.49 When prescribing azithromycin, advise people about the small risk of hearing loss and tinnitus, and tell them to contact a healthcare professional if this occurs. Consider physiotherapy using positive expiratory pressure devices for selected people with exacerbations of COPD, to help with clearing sputum. * See the NICE guideline on chronic heart failure in adults for recommendations on using serum natriuretic peptides to diagnose heart failure. Chronic thromboembolic pulmonary hypertension (group 4) 10.1 Diagnosis 10.2 Therapy 10.2.1 Surgical 10.2.2 Medical 10.2.3 Interventional 11. Published products on … 1.2.54 1.1.28 Perform spirometry in people who are over 35, current or ex‑smokers, and have a chronic cough. [2004], 1.3.47 The person, their family and their physician should be confident that they can manage successfully before they are discharged. Guidance. It includes people who have right heart failure secondary to lung disease and people whose primary pathology is salt and water retention, leading to the development of peripheral oedema (swelling). Offer pneumococcal vaccination and an annual flu vaccination to all people with COPD, as recommended by the Chief Medical Officer. [2019]. NICE Bites is a monthly prescribing bulletin published by North West Medicines Information centre which summarises key recommendations from NICE guidance. References: NICE COPD guidance NG115 December 2018 and July 2019, NG114 & NICE QS10 February 2016 update Camden, Haringey and Islington Stable COPD Treatment Guidelines v10.1 Updated February 2020; Review date: October 2022 Produced by the Camden, Haringey and Islington Responsible Respiratory Prescribing Group [2004], 1.2.37 Take particular caution when using theophylline in older people, because of differences in pharmacokinetics, the increased likelihood of comorbidities and the use of other medications. [2018], 1.2.127 For guidance on the choice of antibiotics see the NICE guideline on antimicrobial prescribing for acute exacerbations of COPD. [2004], 1.1.23 Reconsider the diagnosis of COPD for people who report a marked improvement in symptoms in response to inhaled therapy. Tell them: not to clean the spacer more than monthly, because more frequent cleaning affects their performance (because of a build-up of static), to hand wash using warm water and washing-up liquid, and allow the spacer to air dry. The rehabilitation process should incorporate a programme of physical training, disease education, and nutritional, psychological and behavioural intervention. Ensure that people with cor pulmonale caused by COPD are offered optimal COPD treatment, including advice and interventions to help them stop smoking. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. [2004]. [2004], 1.2.8 Do not use oral corticosteroid reversibility tests to identify which people should be prescribed inhaled corticosteroids, because they do not predict response to inhaled corticosteroid therapy. [2004], 1.3.32 When people 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. [2004], 1.2.116 Warn people with bullous disease that they are at a theoretically increased risk of a pneumothorax during air travel. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. [2018], 1.2.128 At all review appointments, discuss corticosteroid and antibiotic use with people who keep these medicines at home, to check that they still understand how to use them. This guideline sets out an antimicrobial prescribing strategy for acute exacerbations of chronic obstructive pulmonary disease (COPD). 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. 1.2.130 Encourage people with COPD to respond promptly to exacerbation symptoms by following their action plan, which may include: adjusting their short-acting bronchodilator therapy to treat their symptoms, taking a short course of oral corticosteroids if their increased breathlessness interferes with activities of daily living, adding oral antibiotics if their sputum changes colour and increases in volume or thickness beyond their normal day-to-day variation, telling their healthcare professional. Pulmonary rehabilitation is defined as a multidisciplinary programme of care for people with chronic respiratory impairment. COPD is heterogeneous, so no single measure can adequately assess disease severity in an individual. 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