HHE Respiratory 2019 | Page 14

RESPIRATORY COPD: overview of updated NICE guidance The guidance addresses many current clinically relevant issues in the diagnosis and management of patients with COPD but acknowledges that evidence is still lacking or unclear in some areas, leading to recommendations for research Ravijyot Saggu BPharm MRPharmS Clin Dip IP Senior Clinical Pharmacist, University College Hospital London NHS Foundation Trust, London, UK In December 2018, the National Institute for Health and Care Excellence (NICE) published its long-awaited update to the 2010 guideline on chronic obstructive pulmonary disease (COPD) in over 16-year-olds. A long time had elapsed between the update and previous guideline, and other guidance, such as that produced (and updated more frequently) by the Global initiative for chronic Obstructive Lung Disease (GOLD), has been useful in the interim to individualise treatment for patients. This article will outline the significant changes in the NICE guidance. COPD is a progressive long-term condition and leading cause of death and disability; it has an estimated cost to the National Health Service over £800 million pounds per year. The mortality rate in England is roughly 23,000 deaths each year (around one person every 20 minutes). 1 COPD is associated with current or history of smoking and/or biomass fuel/noxious particle exposure and usually affecting people over the age of 35 years (and often diagnosed in their 50’s). The ageing population is living for longer, often with a poorer quality of life, which itself presents a challenge to the healthcare system. Current generations may have started smoking from a younger age than previous, resulting in earlier 14 HHE 2019 | hospitalhealthcare.com onset of poor health. Prevalence is associated with geographical levels of deprivation and is increasing; many millions remain undiagnosed and by 2020, COPD will be the third leading cause of death globally. 1,2 COPD is characterised by breathlessness and cough. Patients will typically experience exacerbations (some patients more so) which negatively impacts disease progression, rates of hospitalisation and readmission and health status. The number of exacerbations in the year prior is the strongest predictor of a patient’s future exacerbation frequency. 3 The rate of lung function decline is faster in the earlier stages of the disease, which can be modified by treatment. 1 The new guideline specifically acknowledges the need for a secure diagnosis, made using signs and symptoms and confirmed through spirometry by appropriately trained healthcare workers (who have up to date skills and are competent in interpreting results). This includes noting exacerbation history, excluding conditions such as asthma/cancer and consideration of alternative diagnoses such as alpha-1 antitrypsin disease. Diagnosis should also be considered in symptomatic individuals with normal spirometry. Oral steroids should not be used for reversibility