Denominator – the number of people with an acute exacerbation of COPD receiving emergency oxygen. Stoller JK. Denominator – the number of people with COPD prescribed an inhaler. 5. Spirometry should be performed by a healthcare professional who has had appropriate training and who has up-to-date skills. People admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (COPD) start a pulmonary rehabilitation programme within 4 weeks of discharge. Proportion of people who smoke who are referred to an evidence-based smoking cessation service. a) Evidence that public sector organisations identify how they will reduce emissions from their vehicle fleets to address air pollution. There is evidence that people who smoke are receptive to smoking cessation advice in all healthcare settings. It clarifies the importance of dual bronchodilation to improve symptoms and to reduce exacerbations, as well as the importance of inhaled corticosteroids in people with a significant asthma component or high eosinophil counts. An individual patient assessment should be carried out before choosing the most appropriate device for delivery of inhaled therapy. NICE guidance and other sources used to create this interactive flowchart. People aged over 35 years who present with a risk factor and one or more symptoms of chronic obstructive pulmonary disease (COPD) have post-bronchodilator spirometry. [, Pulmonary rehabilitation programmes should be held at times that suit people with COPD and in locations that are easy for people with COPD to get to, and have good access for people with disabilities. 1 See the British national formulary (BNF) for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, and administering intravenous antibiotics. For guidance on assessing the need for hospital referral, see NICE guideline: Chronic obstructive pulmonary disease in over 16s (see Useful resources). The built environment can affect the emission of road-traffic-related air pollutants by influencing how and how much people travel, for example, by ensuring good connections to walking and cycling networks. No. Numerator – the number of people in the denominator who are assessed for carbon monoxide levels 4 weeks after the quit date. Providing advice to children, young people and adults with chronic respiratory or cardiovascular conditions (and their families or carers, if appropriate) at routine health appointments will support self-management, improve their awareness of how to protect themselves when outdoor air quality is poor and prevent their condition escalating. NICE Bites No 115, February 2019, includes one topic: chronic obstructive pulmonary disease (COPD). [, Non-invasive ventilation should be given once it is recognised that a person is not responding to 1 hour of optimal medical therapy. Denominator – the number of people identified as smokers in any healthcare setting. a) Evidence of local processes and guidance that ensure planning applications for major developments include proposals to minimise and mitigate road-traffic-related air pollution. Everything NICE has said on diagnosing and managing chronic obstructive pulmonary disease in people aged 16 and over in an interactive flowchart. Denominator – the number of people with COPD prescribed an inhaler who have had their inhaler changed. b) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at their annual review. Most patients with exacerbation of chronic obstructive pulmonary disease (COPD) require oxygen supplementation during an exacerbation. [Adapted from, Non-invasive ventilation is a method of providing ventilatory support that does not require an endotracheal tube. Scenario: End-stage COPD: covers the management of people with COPD that is very severe, unresponsive to usual medical treatment, and associated with … [, The absence of any of the features of a recent acute exacerbation, such as worsening breathlessness, cough, increased sputum production and change in colour of sputum. Review the person's history, paying particular attention to compliance with medication, and details … Proportion of people discharged from hospital after an acute exacerbation of COPD who start a pulmonary rehabilitation programme within 4 weeks of discharge. Increased cough. To ensure early diagnosis, spirometry should be done in primary care when a person presents with a risk factor for COPD (which is usually smoking) and one or more symptoms of COPD. 3. Pathway created: May 2011 Last updated: August 2020. Or FEV1 below 50% with respiratory failure. 1.1.5 If no antibiotic is given, give advice about: symptoms (such as sputum colour changes and increases in volume or thickness) worsen rapidly or significantly or, symptoms do not start to improve within an agreed time or. The public sector fleet is substantial and includes various vehicle types, some of which are highly polluting. 1.1.3 If a sputum sample has been sent for culture and susceptibility testing (in line with the NICE guideline on COPD in over 16s) and an antibiotic has been given: review the choice of antibiotic when results are available and. Such services should target minority ethnic and socioeconomically disadvantaged communities in the local population; it is important to ensure that services are easily accessible by people from these groups and that they are encouraged to use them. Numerator – the number of people in the denominator who are asked if they smoke by their healthcare practitioner. replacing vehicles with zero- or ultra-low-emission vehicles over time, incentives to lease zero- or ultra-low-emission vehicles, training drivers to change their driving style, consolidating and sharing vehicles to ensure efficient use, action to minimise congestion caused by delivery schedules. [Expert opinion]. It covers stable COPD and exacerbations. Denominator – the number of people with an acute exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical therapy. [Adapted from. Assessing proposals to minimise and mitigate road-traffic-related air pollution will help to ensure they are robust and evidence based. Pharmacotherapy interventions act as an aid to help people to stop smoking, and it is important that people who seek support to stop smoking receive the full course of their chosen pharmacotherapy to increase the chances of success. 27 February 2019 Air pollution: outdoor air quality and health (NICE quality standard 181) added. b) Evidence of a local framework for assessing proposals to minimise and mitigate road-traffic-related air pollution in planning applications for major developments. 2. 2 If a person is receiving antibiotic prophylaxis, treatment should be with an antibiotic from a different class. Acute exacerbations of chronic obstructive pulmonary disease. Review of patients in primary care is essential to minimise these risks, and NICE COPD Quality Standard QS10 (2011) recommends that patients hospitalised with an acute exacerbation of COPD are reviewed within 2 weeks of discharge. See the NICE guideline on COPD in over 16s for other recommendations on preventing and managing an acute exacerbation of COPD, including self-management. Wedzicha JA, Miravitlles M, Hurst JR, Calverley PMA, Albert RK, Anzueto A, et al. The recommendations on assessment of a person with an acute exacerbation of COPD are largely based on the NICE clinical guidelines Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing [NICE, 2018a] and Chronic obstructive pulmonary disease in over 16s: diagnosis and management [NICE, 2019a], the clinical guidelines COPD-X: concise guide for primary care [Lung … 3 Hospitalization for COPD exacerbations is common and impacts patients’ disease trajectory, and mortality, with fewer than half of patients hospitalized for exacerbation surviving 5 years. There are several elements of ongoing care that an adult with COPD should start before discharge from hospital, which can improve their outcome. [, A multidisciplinary programme of care for people with chronic respiratory impairment that is individually tailored and designed to optimise each person's physical and social performance and autonomy. Health professionals upper respiratory tract infection in the past 5 days. Antibiotic [, An oxygen saturation (measured with a pulse oximeter) that is persistently 92% or less when the person is in a chronic stable state and is at rest (is not, and has not recently, been exercising). 4 Hospitalization provides an opportunity to optimize care. Proportion of planning applications for major developments granted permission with conditions or obligations to minimise and mitigate road-traffic-related air pollution. Hospital discharge care bundles are designed to ensure that every person leaving hospital receives the best care. Elderly people, or people with learning disabilities, physical disabilities or cognitive impairment may experience difficulties learning and retaining the adequate inhaler technique to ensure that they get the optimal treatment dose. Recommendations. 1.1.2 Consider an antibiotic (see the recommendations on choice of antibiotic) for people with an acute exacerbation of COPD, but only after taking into account: the severity of symptoms, particularly sputum colour changes and increases in volume or thickness beyond the person's normal day-to-day variation, whether they may need to go into hospital for treatment (see the NICE guideline on COPD in over 16s), previous exacerbation and hospital admission history, and the risk of developing complications, previous sputum culture and susceptibility results. COPD Exacerbations: An Official ERS/ATS Clinical Practice Guideline. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. Not troubled by breathlessness except on strenuous exercise, Short of breath when hurrying or walking up a slight hill, Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace, Too breathless to leave the house, or breathless when dressing or undressing. Denominator – the number of people with stable COPD and exercise limitation due to breathlessness. Denominator – the number of people who report that they smoke during face-to-face contact with a healthcare practitioner. c) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after a change in treatment. previous antibiotic use, which may have led to resistant bacteria.Send a sputum sample for culture and susceptibility testing if symptoms have not improved following antibiotic treatment and this has not been done already. 1. It recommends changes to usual practice to maximise the safety of … By publicising their approach, public sector organisations can encourage organisations in other sectors to take action to reduce emissions from their vehicle fleets. : CD009764. Many exacerbations are not caused by bacterial infections so will not respond to antibiotics. Denominator – the number of referrals of people with stable COPD and exercise limitation due to breathlessness to pulmonary rehabilitation programmes. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. NICE has published a Technology Appraisal Guidance (TAG) recommending roflumilast for use within NHS England as an add-on option to treat adults with severe chronic obstructive pulmonary disease (COPD) who continue to experience exacerbations despite triple inhaled therapy. There is currently a lack of evidence-based guidance about the details that should be included in these care bundles. Local authorities should ensure that they assess the impact on vulnerable groups if local charges on certain classes of vehicle in clean air zones are proposed. These are local services providing accessible, evidence based and cost effective support to people who want to stop smoking. This site uses cookies, some may have been set already. Guidelines for home oxygen use in adults, Royal College of Physicians’ National COPD Audit Programme: pulmonary rehabilitation clinical audit and organisational audit, Royal College of Physicians’ National COPD Audit Programme: pulmonary rehabilitation clinical audit, Royal College of Physicians’ National COPD Audit Programme: Pulmonary rehabilitation clinical audit, British Thoracic Society's guideline on pulmonary rehabilitation in adults, NICE’s guideline on chronic obstructive pulmonary disease, British Thoracic Society. Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and exercise limitation due to breathlessness are referred to a pulmonary rehabilitation programme. It updates the NICE December 2018 guideline on diagnosing and managing COPD which had omitted recommendations on triple therapy. The draft clinical guideline on diagnosing and managing COPD states that antibiotic treatment to prevent exacerbations should be offered only to patients most likely to benefit from them. Proportion of people who seek support to stop smoking and who agree to take pharmacotherapy who receive a full course. Proportion of people receiving emergency oxygen for an acute exacerbation of COPD who have their oxygen saturation levels maintained between 88% and 92%. An exacerbation of COPD causes an acute deterioration of respiratory symptoms, particularly increased breathlessness and cough, and increased sputum volume and/or a change in the colour of the sputum. Bronchodilator therapy is usually delivered using a hand-held inhaler device. Numerator – the number in the denominator who start a pulmonary rehabilitation programme within 4 weeks of discharge. Advice may include referral to an evidence-based smoking cessation service. Management of COPD exacerbations: an ERS/ATS guideline. 9 November 2015 Structure revised, and summarised recommendations replaced with full recommendations. Exacerbations of COPD can be associated with the following symptoms: 1. Recording smoking status using carbon monoxide testing after 4 weeks provides an incentive for people who are attempting to stop, and is an objective way to measure individual and service level outcomes. Evidence of local arrangements to ensure that people who smoke who have set a quit date with an evidence-based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date. Hill NS. considering how structures such as buildings and other physical barriers will affect the distribution of air pollutants. 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