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Chronic obstructive pulmonary disease - How up-to-date is this topic?
Changes
Version 1.1, revision planned in 2014.
Last revised in November 2010
February 2011 — minor update. The range of long–acting beta2–agonist inhaler devices included as prescriptions has been updated. Issued in February 2011.
November 2010 — minor update. The Medicines and Healthcare products Regulatory Agency (MHRA) has issued advice that the Spiriva Respimat® formulation of tiotropium should be used with caution in people with known cardiac rhythm disorders [MHRA, 2010]. Issued in November 2010.
July to November 2010 — topic updated. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.
Major changes to the recommendations that are relevant to primary healthcare professionals include:
- Diagnosis
- Spirometry should be measured post-bronchodilator to confirm the diagnosis of chronic obstructive pulmonary disease (COPD).
- Assessment of severity
- NICE recommend a new classification of the severity of airflow obstruction according to forced expiratory volume in one second (FEV1).
- Drug treatment
- Initial decisions about treatment with a long-acting beta-2 agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS) should be made according to whether FEV1 is less than, or greater than or equal to, 50% predicted.
- In people with stable COPD who remain breathless or have exacerbations despite use of short-acting bronchodilators as required, NICE recommends the following as maintenance therapy:
- If FEV1 is greater than or equal to 50% predicted: a LABA or LAMA.
- If FEV1 is less than 50% predicted: LABA with an ICS in a combination inhaler, or a LAMA.
- In people with stable COPD and an FEV1 greater than or equal to 50% who remain breathless or have exacerbations despite maintenance therapy with a LABA, NICE recommends a LABA plus an ICS in a combination inhaler (or a LAMA in addition to a LABA where an ICS is declined or not tolerated).
- However, NICE recommends a LAMA in addition to a LABA plus ICS for people with COPD who remain breathless or have exacerbations despite taking a LABA plus ICS, regardless of their FEV1.
- Pulmonary rehabilitation
- In addition to people who consider themselves functionally disabled by COPD (usually Medical Research Council dyspnoea scale grade 3 and above), pulmonary rehabilitation should be made available to people who have had a recent hospitalization for an acute exacerbation.
- End-stage COPD
- Recommendations on when to discuss end-of-life issues, and on the identification and management of end-stage COPD have been strengthened, in line with a growing awareness of the palliative and information needs of people with end-stage COPD.
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