Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation.

Diagnose COPD

  • A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter 'bronchitis' or wheeze. [2004]

  • The presence of airflow obstruction should be confirmed by performing post-bronchodilator* spirometry. All health professionals involved in the care of people with COPD should have access to spirometry and be competent in the interpretation of the results. [2004] [*added 2010]

Stop smoking

  • Encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity. [2004]

Promote effective inhaled therapy

  • In people with stable COPD who remain breathless or have exacerbations despite use of short-acting bronchodilators as required, offer the following as maintenance therapy:

    • if FEV1 ≥ 50% predicted: either long-acting beta2 agonist (LABA) or long-acting muscarinic antagonist (LAMA)

    • if FEV1 < 50% predicted: either LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or LAMA. [new 2010]

  • Offer LAMA in addition to LABA+ICS to people with COPD who remain breathless or have exacerbations despite taking LABA+ICS, irrespective of their FEV1. [new 2010]

Provide pulmonary rehabilitation for all who need it

  • Pulmonary rehabilitation should be made available to all appropriate people with COPD including those who have had a recent hospitalisation for an acute exacerbation. [new 2010]

Use non-invasive ventilation

  • Non-invasive ventilation (NIV) should be used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff trained in its application, experienced in its use and aware of its limitations.

  • When patients 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]

Manage exacerbations

  • The frequency of exacerbations should be reduced by appropriate use of inhaled corticosteroids and bronchodilators, and vaccinations. [2004]

  • The impact of exacerbations should be minimised by:

    • giving self-management advice on responding promptly to the symptoms of an exacerbation

    • starting appropriate treatment with oral steroids and/or antibiotics

    • use of non-invasive ventilation when indicated

    • use of hospital-at-home or assisted-discharge schemes. [2004]

Ensure multidisciplinary working

  • COPD care should be delivered by a multidisciplinary team. [2004]

  • National Institute for Health and Care Excellence (NICE)