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.
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