Excerpt

This guideline offers best practice advice on the identification and care of patients with chronic obstructive pulmonary disease (COPD). It aims to define the symptoms, signs and investigations required to establish a diagnosis of COPD. It also aims to define the factors that are necessary to assess its severity, provide prognostic information and guide best management. It gives guidance on the pharmacological and non-pharmacological treatment of patients with stable COPD, and on the management of exacerbations. The interface with surgery and intensive therapy units (ITU) are also discussed.

Contents

• Acknowledgements for the original guideline
• Acknowledgements for the update guideline
• Development Group Membership for the original guideline
• NEW 2010 Update guideline development group members
• Preface to original guideline
• Preface to NEW 2010 update guideline
• 1. Introduction
  • 1.1. Definition of chronic obstructive pulmonary disease
  • 1.2. Clinical context
  • 1.3. Original guideline aims
  • 1.4. Patient choice
  • 1.5. Underlying guideline principles
  • 1.6. Structure of the original guideline
  • 1.7. Updating a NICE guideline
  • 1.8. Update aim
  • 1.9. Scope
  • 1.10. Audience
  • 1.11. Involvement of people with COPD
  • 1.12. Guideline limitations
  • 1.13. Other work relevant to the guideline
• 2. Methodology
  • 2.1. The process of guideline development (for a partial update)
  • 2.2. Re-run evidence
  • 2.3. Disclaimer
  • 2.4. Funding
• 3. Hierarchy of evidence and grading of recommendations
• 4. Glossary of terms
• 5. Summary of key priorities for implementation, algorithms and audit criteria
  • 5.1. Key priorities for implementation
  • 5.2. Algorithms
  • 5.3. Suggested audit criteria for implementation
• 6. Diagnosing COPD
  • 6.1. Introduction
  • 6.2. Symptoms
  • 6.3. Signs
  • 6.4. Spirometry
  • 6.5. Differential diagnosis
  • 6.6. Further investigations
  • 6.7. Reversibility testing
  • 6.8. Assessment of severity and prognostic factors
  • 6.9. Assessment and classification of severity of airflow obstruction
  • 6.10. Identification of early disease
  • 6.11. Referral for specialist advice
• 7. Managing stable COPD
  • 7.1. Introduction
  • 7.2. Smoking cessation
  • 7.3. Inhaled therapy
  • 7.4. Oral therapy
  • 7.5. Combined oral and inhaled therapy
  • 7.6. Oxygen
  • 7.7. Non-invasive ventilation
  • 7.8. Management of pulmonary hypertension and cor pulmonale
  • 7.9. Pulmonary rehabilitation
  • 7.10. Vaccination and anti-viral therapy
  • 7.11. Lung surgery
  • 7.12. Alpha-1 antitrypsin replacement therapy
  • 7.13. Multidisciplinary management
  • 7.14. Fitness for general surgery
  • 7.15. Follow-up of patients with COPD
• 8. Management of exacerbations of COPD
  • 8.1. Introduction
  • 8.2. Definition of an exacerbation
  • 8.3. Consequences of having an exacerbation
  • 8.4. Causes of an exacerbation
  • 8.5. Symptoms of an exacerbation
  • 8.6. Differential diagnosis of an exacerbation
  • 8.7. Assessment of the severity of an exacerbation
  • 8.8. Assessment of need for hospital treatment
  • 8.9. Investigation of an exacerbation
  • 8.10. Hospital-at-home and assisted-discharge schemes
  • 8.11. Pharmacological management
  • 8.12. Oxygen therapy during exacerbations of COPD
  • 8.13. Non-invasive ventilation (NIV) and COPD exacerbations
  • 8.14. Invasive ventilation and intensive care
  • 8.15. Respiratory physiotherapy and exacerbations
  • 8.16. Monitoring recovery from an exacerbation
  • 8.17. Discharge planning
• 9. Audit criteria
  • Sentinel events audit
• 10. Areas for Future Research
  • 10.1. General Points
  • 10.2. Specific points
  • 10.3. NEW 2010 UPDATE Future research recommendations
• Appendix A. Details of questions and literature searches
• Appendix B. Cost effectiveness of opportunistic case finding in primary care
• Appendix C. Educational packages
• Appendix D. Economic costs of COPD to the NHS
• Appendix E. Searching for health economics evidence
• Appendix F. Evidence tables
• Appendices for NEW 2010 update
  • Appendix G. NEW 2010 update Scope
  • Appendix H. NEW 2010 update PICO questions
  • Appendix I. NEW 2010 update research protocols
  • Appendix J. NEW 2010 update literature searches
  • Appendix K. NEW 2010 deleted sections from original guideline
  • Appendix L. NEW 2010 update criteria for selecting high-priority research recommendations
  • Appendix M. NEW 2010 update cost effectiveness modelling
  • Appendix N. NEW 2010 COPD update GDG declarations of interest register
  • Appendix O. NEW 2010 COPD update forest plots
• 27 Reference List

The guideline was first published in February 2004 and updated and published in June 2010. Original guideline publish 2004 is copyright to © 2004 Royal College of Physicians of London.

Note to stakeholders:

The Guideline Development Group wish to point out that this is a partial update of an existing guideline, with the integration of new sections into the old publication. This has inevitably led to inconsistencies in style, particularly where new tables and forest plots have been inserted alongside old-style evidence statements, and also where new recommendations (without any gradings) have been added to, or replaced, existing recommendations which do have gradings.

The expanded section on Inhaled Therapy (which now incorporates the previous separate sections on Inhaled Bronchodilators, Inhaled Corticosteroids and Inhaled Combination Therapy) now concludes with a number of new recommendations which have all been grouped together for ease of reference, although this has necessitated their being somewhat removed from their supporting evidence.

Suggested citation:

National Clinical Guideline Centre. (2010) Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care. London: National Clinical Guideline Centre