Dupilumab for maintenance treatment of uncontrolled chronic obstructive pulmonary disease with raised blood eosinophils

offer treatment and support to stop smoking – see the NICE guideline on tobacco: preventing uptake, promoting quitting and treating independence

offer pneumococcal vaccination and an annual influenza vaccination – see the UKHSA Green Book

offer pulmonary rehabilitation if indicated. See NICE's early value assessment on digital technologies to deliver pulmonary rehabilitation programmes for adults with COPD for technologies that can be used in the NHS while more evidence is generated. These can be used to deliver pulmonary rehabilitation programmes for adults who cannot have or do not want face-to-face pulmonary rehabilitation

co-develop a personalised self-management plan. See NICE's early value assessment on digital technologies to support self-management of COPD for technologies that can be used in the NHS while more evidence is generated. These provide components of self-management such as education, symptom tracking, exercise and remote monitoring

optimise treatment for comorbidities – see NICE's guideline on multimorbidity

assess inhaler technique and provide support to improve technique. This may include considering alternative devices if the person finds them easier to use.

are already taking an inhaled corticosteroid plus a LABA and a LAMA (triple therapy), or a LABA and a LAMA (double therapy) if inhaled corticosteroids are not appropriate

have uncontrolled COPD defined as 1 or more severe exacerbations, or 2 or more moderate exacerbations in the previous 12 months. NICE's guideline on COPD defines a moderate exacerbation as one that requires treatment with systemic corticosteroids or antibiotics, and a severe exacerbation as one that requires admission to hospital

have a raised blood eosinophil level defined as a blood eosinophil count of 0.3 x 10^9 cells per litre or more.

azithromycin for people who do not smoke, are having optimised non‑pharmacological and inhaled therapies, are vaccinated, have been referred to pulmonary rehabilitation (if appropriate) and continue to have frequent, prolonged or severe exacerbations (see recommendation 1.2.45 in NICE's guideline on COPD). In February 2026, this was an off-label use of azithromycin (see NICE's information on prescribing medicines)

roflumilast for people with COPD with chronic bronchitis if it is severe, the person had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy, and treatment is started by a specialist (see NICE's technology appraisal guidance on roflumilast for treating COPD).