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
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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