HHE Respiratory 2019 | Page 16

FIGURE 1 Chronic obstructive pulmonary disease in over 16s: non-pharmacological management and use of inhaled therapies Fundamentals of COPD care Confirmed diagnosis of COPD • Offer treatment and support to stop smoking • Offer pneumococcal and influenza vaccinations • Offer pulmonary rehabilitation if indicated • Co-develop a personalised self-management plan • Optimise treatment for comorbidities These treatments and plans should be revisited at every review Start inhaled therapies only if: • all the above interventions have been offered (if appropriate), and • inhaled therapies are needed to relieve breathlessness or exercise limitation Inhaled therapies Offer SABA or SAMA to use if needed Person still breathless or has exacerbations despite treatment? No asthmatic features/features suggesting steroid responsiveness* Asthmatic features/features suggesting steroid responsiveness* Offer LABA + LAMA Consider LABA + ICS For ALL inhaled therapies: Train people in correct inhaler technique, and review medication and assess inhaler technique and adherence regularly Person still breathless or has exacerbations despite further treatment? Offer LAMA + LABA + ICS Explore further treatment options if needed (see guideline) *Asthmatic features/features suggesting steroid responsiveness in this context include any previous secure diagnosis of asthma or atopy, a higher blood eosinophil count, substantial variation in FEV1 over time (at least 400 ml) or substantial diurnal variation in peak expiratory flow (at least 20%). This is a summary of the recommendations on non-pharmacological management of chronic obstructive pulmonary disease and use of inhaled therapies in people over 16. The guideline also covers diagnosis and other areas of management. See www.nice.org.uk/guidance/NG115. © NICE 2018. All rights reserved. Subject to Notice of rights. 16 HHE 2019 | hospitalhealthcare.com