[2004], 1.2.44 Anti-tussive therapy should not be used in the management of stable COPD. [2010], 1.2.43 Treatment with alpha-tocopherol and beta-carotene supplements, alone or in combination, is not recommended. [2018], 1.2.53 Advise people on spacer cleaning. [2018]. Everything NICE has said on diagnosing and managing chronic obstructive pulmonary disease in people aged 16 and over in an interactive flowchart [2018]. 1.2.1 For guidance on the management of multimorbidity, see the NICE guideline on multimorbidity. [2018], 1.2.60 For people who smoke or live with people who smoke, but who meet the other criteria for long-term oxygen therapy, ensure the person who smokes is offered smoking cessation advice and treatment, and referral to specialist stop smoking services (see the NICE guidelines on stop smoking interventions and services and medicines optimisation). 115 Chronic obstructive pulmonary disease 115; 2018 Definition of terms COPD chronic obstructive pulmonary disease FEV1 forced expiratory volume in 1 second FVC forced vital capacity ICS inhaled corticosteroids LABA long-acting beta2 agonists 2 Short of breath when hurrying or walking up a slight hill. 1.2.30 Do not continue nebulised therapy without assessing and confirming that 1 or more of the following occurs: an increase in the ability to undertake activities of daily living, 1.2.31 Use a nebuliser system that is known to be efficient[3]. 1.3.1 Use the factors in table 7 to assess whether people with COPD need hospital treatment. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation … 1 This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations. 1.2.89 At the respiratory review, refer the person with COPD to a lung volume reduction multidisciplinary team to assess whether lung volume reduction surgery or endobronchial valves are suitable if they have: hyperinflation, assessed by lung function testing with body plethysmography and, emphysema on unenhanced CT chest scan and, optimised treatment for other comorbidities. For people who are using long-acting bronchodilators outside of recommendations 1.2.11 and 1.2.12 and whose symptoms are under control, explain to them that they can continue with their current treatment until both they and their NHS healthcare professional agree it is appropriate to change. 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], 1.2.108 People with end-stage COPD and their family members or carers (as appropriate) should have access to the full range of services offered by multidisciplinary palliative care teams, including admission to hospices. [2004, amended 2018], Night time waking with breathlessness and/or wheeze, Significant diurnal or day-to-day variability of symptoms, 1.1.20 In addition to the features in table 3, use longitudinal observation of people (with spirometry, peak flow or symptoms) to help differentiate COPD from asthma. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. [2004], 1.2.115 Assess people with an FEV1 below 50% predicted who are planning air travel in line with the BTS recommendations. [2004]. [2004], 1.2.76 It is recommended that the diagnosis of cor pulmonale is made clinically and that this process should involve excluding other causes of peripheral oedema (swelling). For people with mild airflow obstruction, only diagnose COPD if they have one or more of the symptoms in recommendation 1.1.1. [2004], 1.2.29 Do not prescribe nebulised therapy without an assessment of the person's and/or carer's ability to use it. [2004, amended 2018], 1.2.69 Prescribe ambulatory oxygen to people who are already on long-term oxygen therapy, who wish to continue oxygen therapy outside the home, and who are prepared to use it. 1.1.1 [2018], 1.2.129 See recommendations 1.3.13 to 1.3.20 for more guidance on oral corticosteroids. 1.2.21 In most cases bronchodilator therapy is best administered using a hand-held inhaler (including a spacer if appropriate). [2004, amended 2018], 1.3.4 Hospital-at-home and assisted-discharge schemes are safe and effective and should be used as an alternative way of caring for people with exacerbations of COPD who would otherwise need to be admitted or stay in hospital. To find out why the committee made the 2018 recommendation on risk factors for exacerbations and how it might affect practice see rationale and impact. [2018]. have a PaO2 above 7.3 and below 8 kPa when stable, if they also have 1 or more of the following: 1.2.59 Conduct and document a structured risk assessment for people being assessed for long-term oxygen therapy who meet the criteria in recommendation 1.2.58.

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