4 Research recommendations

The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future.

4.1 Pulmonary rehabilitation during hospital admission

In people with COPD, does pulmonary rehabilitation during hospital admission for exacerbation and/or in the early recovery period (within 1 month of an exacerbation) improve quality of life and reduce hospitalisations and exacerbations compared to a later (defined as after 1 month) pulmonary rehabilitation programme?

Why this is important

The greatest reconditioning and potential benefit from rehabilitation may occur in the early post-exacerbation phase. If inpatient pulmonary rehabilitation is demonstrated to be effective this may potentially impact upon service delivery (for example, early discharge schemes). The cost effectiveness of early versus later pulmonary rehabilitation programmes should also be evaluated. Studies should be cluster randomised, be of sufficiently long duration and be adequately powered.

4.2 Multidimensional assessment of outcomes

Could a simple multidimensional assessment be used to give a better indication of COPD outcomes than either FEV1 or other components measured alone in a wide range of COPD patients, and applicable in a primary care setting?

Why this is important

The BODE index assessment is time-consuming and impractical in a primary-care setting. The GDG considered that people entering COPD studies should be characterised by the BODE index to assess whether it has an effect on outcome. Multidimensional assessments should be validated in a general UK COPD population, and in a primary-care setting, in a wider range of outcomes than mortality. Any multidimensional assessment index would need to be subjected to health economic evaluation. All clinical studies of sufficiently long duration should routinely include health economic evaluation.

4.3 Triple therapy

In people with COPD, does triple therapy improve outcomes when compared with single or double therapy?

Why this is important

Currently available studies were not designed or powered to assess whether people with mild COPD on single therapy with LABA or LAMA or double therapy with LABA+ICS might benefit from triple therapy. All clinical studies of sufficiently long duration should routinely include health economic evaluation.

4.4 Mucolytic therapy

In people with COPD, does mucolytic drug therapy prevent exacerbations in comparison with placebo and other therapies?

Why this is important

People with COPD should have a definitive diagnosis of COPD. Baseline severity and clinical phenotype should be well defined. Concomitant therapies should be stratified in the study design. Comparisons should be made with other effective therapies as well as placebo.

  • National Institute for Health and Care Excellence (NICE)