Chronic Obstructive Pulmonary Disease - Management in Adults in Primary and Secondary Care
Description:
This report provides guidelines on the management of Chronic Obstructive Pulmonary Disease ( COPD ) in adults in primary and secondary care. A diagnosis of Chronic Obstructive Pulmonary Disease ( COPD ) should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze. The presence of airflow obstruction should be confirmed by performing spirometry. All health professionals managing patients with Chronic Obstructive Pulmonary Disease ( COPD ) should have access to spirometry and be competent in the interpretation of the results. Encouraging patients with Chronic Obstructive Pulmonary Disease ( COPD ) to stop smoking is one of the most important components of their management. All Chronic Obstructive Pulmonary Disease ( COPD ) patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity. Long-acting inhaled bronchodilators (beta2-agonists and/or anticholinergics) should be used to control symptoms and improve exercise capacity in patients who continue to experience problems despite the use of short-acting drugs. Inhaled corticosteroids should be added to long-acting bronchodilators to decrease exacerbation frequency in patients with an FEV1 less than or equal to 50% predicted who have had two or more exacerbations requiring treatment with antibiotics or oral corticosteroids in a 12-month period. Pulmonary rehabilitation for all who need it - Pulmonary rehabilitation should be made available to all appropriate patients with COPD. Non-invasive ventilation should be used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff trained in its application, experienced in its use and aware of its limitations. When patients are started on non-invasive ventilation , there should be a clear plan covering what to do in the event of deterioration and ceilings of therapy should be agreed. The frequency of exacerbations should be reduced by appropriate use of inhaled corticosteroids and bronchodilators, and vaccinations. Chronic Obstructive Pulmonary Disease ( COPD ) care should be delivered by a multidisciplinary team. More information and updates at NICE/NHS (National Institute for Clinical Excellence), London, UK.

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