NICE issues guideline for management of COPD
A guideline for the management of chronic obstructive pulmonary disease has been issued by the National Institute for Clinical Excellence and the National Collaborating Centre for Chronic Conditions.
David Halpin: pharmacists are well placed to educate patients
about COPD |
Speaking at a press briefing in London this week, David Halpin, consultant
physician and chair of the guideline development group, said that although
the guideline makes nearly 200 recommendations for primary and secondary
care, these can be split into seven key areas: diagnosis, smoking cessation,
effective inhaled therapy, pulmonary rehabilitation, non-invasive ventilation,
managing exacerbations and multidisciplinary working.
The guideline states that all COPD patients who smoke should be encouraged
to stop at every opportunity and offered bupropion or nicotine replacement
therapy, combined with a support programme. It also recommends a step-wise
approach to treating breathlessness and exercise limitation as follows:
· Initially, a short-acting bronchodilator (beta2-agonist or anticholinergic)
should be used as needed
· If the patient is still symptomatic, combine a short-acting beta2-agonist
and a short-acting anticholinergic drug
· If the patient is still symptomatic, use a long-acting bronchodilator
(beta2-agonist or anticholinergic)
· If the patient has moderate or severe COPD and is still symptomatic,
a combination of a long-acting bronchodilator and inhaled steroid should
be considered
· Theophylline may be added if symptoms persist
The guideline also suggests that patients at risk of exacerbations should
be given courses of antibiotics and corticosteroids to keep at home so
that, initially, they can self-manage exacerbations.
About 900,000 people in the UK have diagnosed COPD and NICE estimates
that many more remain undiagnosed. Pharmacists could help to identify
these people by determining whether a cough is a simple episode, related
to a cold, or if it could be related to a chronic condition, said Dr
Halpin.
The full NICE guideline will be published in Thorax and a short version
is available online at www.nice.org.uk.
The Royal Pharmaceutical Society is to update its guidance on the care
of people with asthma and COPD, taking the new NICE guideline into consideration.
COPD campaign The
British Thoracic Society is encouraging pharmacists to join a COPD
awareness campaign by displaying a poster entitled “Trouble
with breathing?”, which urges people to seek advice if they
have a persistent smoker’s cough, breathlessness on mild
exertion, persistent production of phlegm or frequent coughs and
colds in the
winter. The free poster can be obtained by visiting here
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