To find out why the committee made the 2018 recommendations on managing pulmonary hypertension and cor pulmonale and how they might affect practice, see rationale and impact. . 1.2.100 , 1.2.72 When choosing which equipment to prescribe, take account of the hours of ambulatory oxygen use and oxygen flow rate needed. , 1.2.84 Pulmonary rehabilitation programmes should include multicomponent, multidisciplinary interventions that are tailored to the individual person's needs. To find out why the committee made the 2018 recommendations on long-term oxygen therapy and how they might affect practice, see rationale and impact. Whenever possible, use features from the history and examination (such as those listed in table 3) to differentiate COPD from asthma. , Degree of breathlessness related to activities, Not troubled by breathlessness except on strenuous exercise, Short of breath when hurrying or walking up a slight hill, Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace, Stops for breath after walking about 100 metres or after a few minutes on level ground, Too breathless to leave the house, or breathless when dressing or undressing. Offer pulmonary rehabilitation to all people who view themselves as functionally disabled by COPD (usually Medical Research Council [MRC] grade 3 and above). 1.2.137 1.2.1 For guidance on the management of multimorbidity, see the NICE guideline on multimorbidity. . ... 2019 guidelines by the National Institute for Health and Care Excellence (NICE) on antimicrobial prescribing guidance for managing common infections. 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 NICE has also produced a visual summary covering non-pharmacological management and use of inhaled therapies. 1.2.58 Fluoroquinolone antibiotics: In September 2019, this guideline was updated to reflect MHRA restrictions and precautions for the use of fluoroquinolone antibiotics following rare reports of disabling and potentially long-lasting or irreversible side effects (see Drug Safety Update and update information for details). Consider LABA+ICS for people who: have asthmatic features/features suggesting steroid responsiveness and, 1.2.13 2 Short of breath when hurrying or walking up a slight hill. , 1.2.43 Treatment with alpha-tocopherol and beta-carotene supplements, alone or in combination, is not recommended. . Advise people with COPD that the following factors increase their risk of exacerbations: continued smoking or relapse for ex‑smokers, seasonal variation (winter and spring). , 1.3.40 Do not routinely perform daily monitoring of peak expiratory flow (PEF) or FEV1 to monitor recovery from an exacerbation, because the magnitude of changes is small compared with the variability of the measurement. , 1.3.20 , 1.2.105 Pay attention to changes in weight in older people, particularly if the change is more than 3 kg. To assess cardiac status if cardiac disease or pulmonary hypertension are suspected because of: • a history of cardiovascular disease, hypertension or hypoxia or, • clinical signs such as tachycardia, oedema, cyanosis or features of cor pulmonale, To assess cardiac status if cardiac disease or pulmonary hypertension are suspected, To investigate symptoms that seem disproportionate to the spirometric impairment, To investigate signs that may suggest another lung diagnosis (such as fibrosis or bronchiectasis), To investigate abnormalities seen on a chest X-ray, To assess suitability for lung volume reduction procedures, To assess for alpha-1 antitrypsin deficiency if early onset, minimal smoking history or family history, Transfer factor for carbon monoxide (TLCO). , 1.3.23 Take care when using intravenous theophylline, because of its interactions with other drugs and potential toxicity if the person has been taking oral theophylline. . , 1.2.132 Composite assessment tools such as the ASA scoring system are the best predictors of risk.  The MHRA has published an alert on the risk of death and severe harm from failure to obtain and continue flow from oxygen cylinders (2018). . Published date: To find out why the committee made the 2018 recommendations on incidental findings on chest X‑ray or CT scans and how they might affect practice, see rationale and impact. , 1.2.85 Advise people of the benefits of pulmonary rehabilitation and the commitment needed to gain these. , 1.2.104 For guidance on nutrition support, see the NICE guideline on nutrition support for adults. , 1.2.52 , 1.2.140 When people with very severe COPD are reviewed in primary care they should be seen at least twice per year, and specific attention should be paid to the issues listed in table 6. , 1.1.8 All healthcare professionals who care for people with COPD should have access to spirometry and be competent in interpreting the results. , 1.2.20 , 1.1.10 Spirometry services should be supported by quality control processes. . 1.2.67 Do not offer routine telehealth monitoring of physiological status as part of management for stable COPD. . Advise people on spacer cleaning. An exacerbation is a sustained worsening of the patient's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset. Severity assessment is, nevertheless, important because it has implications for therapy and relates to prognosis.  British Thoracic Society Standards of Care Committee (2002) Managing passengers with respiratory disease planning air travel: British Thoracic Society recommendations. . A significant proportion of these people will go on to develop airflow limitation. , 1.3.29 Measure arterial blood gases and note the inspired oxygen concentration in all people who arrive at hospital with an exacerbation of COPD. , 1.3.13 Before starting azithromycin, ensure the person has had: an electrocardiogram (ECG) to rule out prolonged QT interval and, 1.2.49 When prescribing azithromycin, advise people about the small risk of hearing loss and tinnitus, and tell them to contact a healthcare professional if this occurs. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. NICE has produced a COVID-19 rapid guideline on community-based care of patients with chronic obstructive pulmonary disease (COPD). , 1.2.115 Assess people with an FEV1 below 50% predicted who are planning air travel in line with the BTS recommendations. 1.2.46 Consider azithromycin (usually 250 mg 3 times a week) for people with COPD if they: have optimised non-pharmacological management and inhaled therapies, relevant vaccinations and (if appropriate) have been referred for pulmonary rehabilitation and. Develop an individualised self-management plan in collaboration with each person with COPD and their family members or carers (as appropriate), and: include education on all relevant points from recommendation 1.2.121, review the plan at future appointments. 26 July 2019. It includes people who have right heart failure secondary to lung disease and people whose primary pathology is salt and water retention, leading to the development of peripheral oedema (swelling). , 1.2.129 See recommendations 1.3.13 to 1.3.20 for more guidance on oral corticosteroids. 1.3.21 For guidance on using antibiotics to treat COPD exacerbations, see the NICE guideline on antimicrobial prescribing for acute exacerbations of COPD. . Pulmonary rehabilitation is defined as a multidisciplinary programme of care for people with chronic respiratory impairment. 1.2.56 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. Chronic obstructive pulmonary disease in over 16s: Diagnosis and management1RELEASE DATE: December 5, 2018 with update July 2019 PRIOR VERSION(S): NICE guideline CG101 June 2010, 2004 FUNDING SOURCE: Department of Health and Social Care, United Kingdom TARGET POPULATION: Patients age 16 and older with Chronic Obstructive Pulmonary Disease (COPD) GUIDELINE TITLE: … 1.2.88 1.2.11 , 1.2.68 , 1.2.24 People with COPD should have their ability to use an inhaler regularly assessed and corrected if necessary by a healthcare professional competent to do so. . Offer LAMA+LABA to people who: do not have asthmatic features/features suggesting steroid responsiveness and. For people who need treatment for hypoxia, see the section on long-term oxygen therapy. 1.2.15 For people with COPD who are taking LABA+ICS, offer LAMA+LABA+ICS if: their day-to-day symptoms continue to adversely impact their quality of life or, they have a severe exacerbation (requiring hospitalisation) or, they have 2 moderate exacerbations within a year. Dr Hopkinson will discuss the five fundamentals of COPD care: offer treatment and support to stop smoking European Respiratory Society Guideline on Long-term Home Non-Invasive Ventilation for Management of Chronic Obstructive Pulmonary Disease B. Ergan, S. Oczkowski, B. Rochwerg, et al. 1.2.103 Calculate BMI for people with COPD: the normal range for BMI is 20 to less than 25 kg/m2, refer people for dietetic advice if they have a BMI that is abnormal (high or low) or changing over time, for people with a low BMI, give nutritional supplements to increase their total calorific intake and encourage them to exercise to augment the effects of nutritional supplementation. 1.2.126 Chronic thromboembolic pulmonary hypertension (group 4) 10.1 Diagnosis 10.2 Therapy 10.2.1 Surgical 10.2.2 Medical 10.2.3 Interventional 11. , 1.2.32 Offer people a choice between a facemask and a mouthpiece to administer their nebulised therapy, unless the drug specifically requires a mouthpiece (for example, anticholinergic drugs). Since 2010, the management of COPD has changed dra- PRIOR VERSION (S): NICE guideline CG101 June 2010, 2004. The diagnosis of chronic obstructive pulmonary disease (COPD) depends on thinking of it as a cause of breathlessness or cough. 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