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Chronic obstructive pulmonary disease - Management
Basis for recommendation

These recommendations are based on two National Institute for Health and Clinical Excellence (NICE) guidelines: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update) [National Clinical Guideline Centre, 2010; NICE, 2010] and Referral guidelines for suspected cancer [NICE, 2005].

  • The NICE guidelines on referral for suspected cancer and the NICE chronic obstructive pulmonary disease (COPD) guideline differ slightly in their guidance on the management of a person with haemoptysis.
    • The NICE guidelines on referral for suspected cancer indicate that a single episode of haemoptysis necessitates an urgent chest X-ray and non-urgent referral if the chest X-ray shows no signs of lung cancer, whilst only persistent haemoptysis or chest X-ray signs of possible lung cancer require urgent referral [NICE, 2005].
    • The NICE COPD guideline recommends referral for specialist advice if a person with COPD develops haemoptysis to exclude lung cancer [NICE, 2010].
    • Given that urgent referral is required if lung cancer is suspected, CKS recommends urgent referral if a person with COPD reports haemoptysis. This recommendation is supported by several CKS reviewers.
  • The other indications for referral were originally developed by the British Thoracic Society [British Thoracic Society, 1997] and were augmented by the NICE COPD guideline development group [National Clinical Guideline Centre, 2010].
  • Precise definitions of 'dysfunctional breathing' are scarce in the published literature; the definition here is based on a study of the prevalence of this problem in people with asthma [Thomas et al, 2001].

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