Review the person's history, paying particular attention to compliance with medication, and details … Local planning authorities assess proposals to minimise and mitigate road-traffic-related air pollution in planning applications for major developments. NICE has produced a COVID-19 rapid guideline on community-based care of patients with chronic obstructive pulmonary disease (COPD). Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019). guided by susceptibilities when available) Proportion of people who seek support to stop smoking and who agree to take pharmacotherapy who receive a full course. 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. Assessing inhaler technique should happen at the first prescription once a person has been taught the correct technique, and then be reassessed regularly (for example, at their annual review, if their treatment changes or after an acute exacerbation) throughout the duration of a person’s treatment in primary, community and secondary care services. To identify organisms if sputum is persistently present and purulent, To exclude asthma if diagnostic doubt remains. It covers stable COPD and exacerbations. Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT. Proportion of people receiving emergency oxygen for an acute exacerbation of COPD who have their oxygen saturation levels maintained between 88% and 92%. 6, 500 mg three times a day (see BNF for dosage in severe infections), 960 mg twice a day (see BNF for dosage in severe infections), 4.5 g three times a day (see BNF for dosage in severe infections), Consult local microbiologist; guided by susceptibilities. Denominator – the number of people who report that they smoke during face-to-face contact with a healthcare practitioner. Celli BR, MacNee W, Agusti A et al. Children, young people and adults with chronic respiratory or cardiovascular conditions are given advice at routine health appointments on what to do when outdoor air quality is poor. Numerator – the number of people in the denominator who receive behavioural support with pharmacotherapy from an evidence-based smoking cessation service. A placeholder statement is an area of care that has been prioritised by the Quality Standards Advisory Committee but for which no source guidance is currently available. The consensus view on the role of ICS in COPD is in the reduction of exacerbations and not in the treatment of breathlessness. They emphasise the key interventions in the management pathway, including details of settings for care and treatment. 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. More severe degrees of acidosis, such as pH <7.25, have been used as a threshold for considering provision of invasive mechanical ventilation. Denominator – the number of people with COPD prescribed an inhaler who have had their inhaler changed. A summary of further considerations relating to pharmacotherapy is provided in quality statement 4. 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. considering how structures such as buildings and other physical barriers will affect the distribution of air pollutants. Increased dyspnoea. b) Rate of hospital attendance or admission for respiratory or cardiovascular exacerbations. [Adapted from, Non-invasive ventilation is a method of providing ventilatory support that does not require an endotracheal tube. For guidance on antibacterial treatment in acute exacerbations of COPD, see Chronic obstructive pulmonary disease, acute exacerbations in Respiratory system infections, antibacterial therapy . Denominator – the number of people with an acute exacerbation of COPD receiving emergency oxygen. [, 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). This can vary by healthcare setting. 3 People who may be at a higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous or current sputum culture with resistant bacteria, or people at higher risk of developing complications. some people at risk of exacerbations may have antibiotics to keep at home as part of their exacerbation action plan (see the recommendations on choice of antibiotic).See the NICE guideline on COPD in over 16s. Wedzicha JA, Miravitlles M, Hurst JR, Calverley PMA, Albert RK, Anzueto A, et al. [Adapted from, Acute acidotic hypercapnic respiratory failure results from an inability of the respiratory system to provide sufficient alveolar ventilation to maintain a normal arterial PCO2 and blood pH level. 4. 1. a) Evidence that public sector organisations identify how they will reduce emissions from their vehicle fleets to address air pollution. LTOT is used to treat people with stable COPD who have developed daytime hypoxaemia. Proportion of people with an exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical treatment who have non-invasive ventilation. Proportion of 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. A full course for NRT is at least 8 weeks, for varenicline it is at least 12 weeks and for bupropion it is at least 8 weeks. This NICE Pathway covers diagnosing and managing, 5 August 2020 Electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease (NICE interventional procedures guidance 677) added to, 12 September 2019 Updated table on antibiotic treatment for adults aged 18 years and over in. Denominator – the number of people with COPD prescribed an inhaler for more than 12 months. 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. There should be a discussion about risks and benefits of using NRT with young people aged 12–17 and pregnant or breastfeeding women. “The latest NICE guidance on COPD has managed to maintain a simplicity that makes sense to most clinicians. It is important that people who smoke who receive pharmacotherapy receive a full course, which will vary depending on the individual smoker. During an exacerbation, people with COPD may experience a worsening of gas exchange in the lungs, which can lead to low blood oxygen levels. include a defined, structured education programme. c) Proportion of attendances of people with stable COPD and exercise limitation due to breathlessness that result in the person completing a pulmonary rehabilitation programme. Denominator – the number of children, young people and adults with chronic respiratory or cardiovascular conditions attending a routine health appointment. Advice should be culturally appropriate and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. development carried out on a site having an area of 1 hectare or more. A summary of prescribing recommendations from NICE guidance NICE Bites February 2019: No. People with COPD need to use their inhaler correctly to receive the optimal treatment dose. Denominator – the number of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD. An individual patient assessment should be carried out before choosing the most appropriate device for delivery of inhaled therapy. Numerator – the number in the denominator with conditions or obligations to minimise and mitigate road-traffic-related air pollution. NICE guidance and other sources used to create this interactive flowchart. All rights reserved. Restrict use of antibiotics for COPD NICE says BMJ 2018 ; 362;k3016 ... Art. This statement is linked to statement 1, because advice on how to stop may include a referral to an evidence-based smoking cessation service. NICE guideline NG115, NICE's guideline on chronic obstructive pulmonary disease, British Thoracic Society. a) Proportion of people with stable COPD and exercise limitation due to breathlessness who are referred to a pulmonary rehabilitation programme. Denominator – the number of people with COPD prescribed an inhaler. These are local services providing accessible, evidence based and cost effective support to people who want to stop smoking. [, 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. Denominator – the number of people with stable COPD and a persistent resting stable oxygen saturation level of 92% or less. : CD009764. 2. Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting: randomised controlled trial. 6 August 2015 Smoking: supporting people to stop (NICE quality standard 43) added. The exacerbations of copd path for the chronic obstructive pulmonary disease pathway. People who smoke are offered behavioural support with pharmacotherapy by an evidence-based smoking cessation service. [. Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the world1 but is projected to be the 3rd leading cause of death by 2020. Evidence of local arrangements and written clinical protocols to ensure that people receiving emergency oxygen for an acute exacerbation of COPD have their oxygen saturation levels maintained between 88% and 92%. (2004) Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Local authorities should be strategic leaders of local initiatives to address air pollution, working in a coordinated way with key partners to ensure a consistent and planned approach. b) Overall fuel consumption for public sector vehicle fleets. 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. An acute exacerbation is a sustained worsening of a person's symptoms from their stable state, and which is beyond usual day-to-day variations and acute in onset. It aims to help people with COPD to receive a diagnosis earlier so that they can benefit from treatments to reduce symptoms, improve quality of life and keep them healthy for longer. Co-existent hypoxaemia is usually mild and easily corrected. NICE guideline [NG114] Numerator – the number in the denominator that result in the person attending a pulmonary rehabilitation programme. For guidance on assessing the need for hospital referral, see NICE guideline: Chronic obstructive pulmonary disease in over 16s (see Useful resources). The public sector fleet is substantial and includes various vehicle types, some of which are highly polluting. This classification has been widely used to determine the severity of exacerbation in research studies, with more symptoms indicating a more severe exacerbation. Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post-bronchodilator spirometry. Short of breath when hurrying or walking up a slight hill. If they have not been taking their inhaled corticosteroid consistently, explain that restarting regular use may help them to regain control of their asthma. 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. People with COPD and a persistent resting stable oxygen saturation of 92% or less should be assessed for their suitability for LTOT, which can improve survival, pulmonary haemodynamics, polycythaemia and neuropsychological health. Development involving any one or more of the following: Local planning authorities should ensure that proposals to encourage active travel in planning applications for major developments are accessible to people with limited mobility or disabilities. People admitted to hospital for an acute exacerbation of chronic obstructive pulmonary disease (COPD) start a pulmonary rehabilitation programme within 4 weeks of discharge. 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 … Chronic obstructive pulmonary disease (COPD), projected to be the third leading cause of death by 2020, accounts for 6% of deaths globally. A diagnosis of COPD is confirmed by post-bronchodilator spirometry. 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. British Medical Journal 2: 257–66. A placeholder statement indicates the need for evidence-based guidance to be developed in this area. a history of cardiovascular disease, hypertension or hypoxia, clinical signs such as tachycardia, oedema, cyanosis or features of cor pulmonale, Need for referral to specialist and therapy services, Need for social services and occupational therapy input, mild exacerbation: the person has an increased need for medication, which they can manage in their own normal environment, moderate exacerbation: the person has a sustained worsening of respiratory status that requires treatment with systemic corticosteroids and/or antibiotics. Evidence-based smoking cessation 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. Dr Karen Sennett highlights key learning points for primary care from the updated NICE guideline on chronic obstructive pulmonary disease (COPD) Welcome to Guidelines in Practice. Numerator – the number of people in the denominator who receive a full course of pharmacotherapy. Numerator – the number in the denominator whose oxygen saturation levels are maintained between 88% and 92%. NICE has published new guidance on prescribing antibiotics for acute exacerbations of chronic obstructive pulmonary disease (COPD) . a) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at the start of treatment. Hill NS. Subject to Notice of rights. 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. 24 March 2015 Insertion of endobronchial nitinol coils to improve lung function in emphysema (NICE interventional procedures guidance 517) added. Spirometry should be performed by a healthcare professional who has had appropriate training and who has up-to-date skills. 25 July 2019 Updated on publication of the update of chronic obstructive pulmonary disease in over 16s: diagnosis and management (NICE guideline NG115). Numerator – the number of people in the denominator who are asked if they smoke by their healthcare practitioner. Numerator – the number of people in the denominator who are assessed for carbon monoxide levels 4 weeks after the quit date. [Expert opinion]. a) Proportion of zero- or ultra-low-emission vehicles in public sector vehicle fleets. It is therefore important that healthcare practitioners proactively ask people if they smoke, and offer advice on how to stop. Walks slower than contemporaries on level ground because of breathlessness, or has to stop for breath when walking at own pace. People who smoke are offered a referral to an evidence-based smoking cessation service. It updates the NICE December 2018 guideline on diagnosing and managing COPD which had omitted recommendations on triple therapy. cannot take oral medicines (to explore locally available options for giving intravenous antibiotics at home or in the community, rather than in hospital, where appropriate). People who smoke are more likely to stop smoking if they are offered a combination of interventions, with combined behavioural support and pharmacotherapy the most likely to be successful. Malaise. The 2010 NICE guidelines [ 5] concluded that, in the absence of significant contraindications, oral corticosteroids should be used in conjunction with other therapies in all patients admitted to hospital with an exacerbation of COPD and considered in patients in the community who have an exacerbation with a significant increase in breathlessness that interferes with daily activities. 05 December 2018, an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of symptoms from a person's stable state, a range of factors (including viral infections and smoking) can trigger an exacerbation, many exacerbations (including some severe exacerbations) are not caused by bacterial infections so will not respond to antibiotics. Denominator – the number of people who have face-to-face contact with a healthcare practitioner. 4 December 2018 Update of chronic obstructive pulmonary disease in over 16s: diagnosis and management (NICE guideline NG115). It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. the person becomes systemically very unwell. the winning and working of minerals or the use of land for mineral-working deposits, the number of dwelling houses to be provided is 10 or more or, the development is to be carried out on a site having an area of 0.5 hectares or more and the number of dwelling houses is not known, the provision of a building or buildings where the floor space to be created by the development is 1,000 square metres or more or. 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. b) Proportion of people who smoke who receive advice on how to stop. Numerator – the number of people in the denominator who receive advice on how to stop. d) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after an acute exacerbation. Most patients with exacerbation of chronic obstructive pulmonary disease (COPD) require oxygen supplementation during an exacerbation. 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. Proportion of children, young people and adults with chronic respiratory or cardiovascular conditions attending a routine health appointment that were given advice on what to do when outdoor air quality is poor. No. Children and young people aged 5 to 16 to contact a healthcare professional for a review if their asthma control deteriorates. e) Evidence that local authorities identify key actions to address air pollution and monitor progress against them. Denominator – the number of planning applications for major developments granted permission. NICE Bites is a monthly prescribing bulletin published by North West Medicines Information centre which summarises key recommendations from NICE guidance. Evidence of local arrangements to ensure that people are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. NICE Bites No 115, February 2019, includes one topic: chronic obstructive pulmonary disease (COPD). only change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving (using a narrow-spectrum antibiotic wherever possible). respiratory rate increase or heart rate increase 20% above baseline. Stoller JK. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. The key components of their approach should include enabling zero- and low-emission travel (including active travel such as cycling or walking) and developing buildings and spaces to reduce exposure to air pollution. Local authorities should ensure that strategic plans identify areas where air pollution is highest and, in particular, locations where people who are vulnerable to air pollution may be exposed to high levels of air pollution, such as schools, nurseries, hospitals and care homes, so that targeted approaches can be put in place. the risk of antimicrobial resistance with repeated courses of antibiotics. 1.1.4 If an antibiotic is given, give advice: about possible adverse effects of the antibiotic, particularly diarrhoea, that symptoms may not be fully resolved when the antibiotic course has been completed, symptoms worsen rapidly or significantly or, symptoms do not start to improve within 2–3 days (or other agreed time) or. PCRS and other organisations advised that this omission would render the guideline out of date on It recommends changes to usual practice to maximise the safety of … 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. a) Frequency of non-invasive ventilation due to oxygen toxicity. An acute exacerbation of COPD is a sustained worsening of symptoms from a person’s stable disease state. In the context of primary care settings, this would involve evidence-based, opportunistic advice offered to people who smoke about the options and support available to help them stop smoking. There is evidence that people who smoke are receptive to smoking cessation advice in all healthcare settings. People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course. Guideline on pulmonary rehabilitation in adults, British Thoracic Society’s guideline on pulmonary rehabilitation in adults, Smoking: stopping in pregnancy and after childbirth, Smoking: acute, maternity and mental health services, National Centre for Smoking Cessation and Training, Statistics on NHS Stop Smoking Services: England, April 2011 – March 2012, stopping smoking in pregnancy and after childbirth, Statistics on NHS Stop Smoking Services: England, April 2011–March 2012, Department for Environment, Food and Rural Affairs’ Local Air Quality Management annual status report, Department for Transport National Travel Survey, Department of Environment Food and Rural Affairs’ UK Air Information Resource, NICE’s guideline on air pollution: outdoor air quality and health, Town and Country Planning (Development Management Procedure; England) Order 2015, Section 2, Sustainable Development Unit’s Health Outcomes of Travel Tool (HOTT), Department for Environment, Food and Rural Affairs’ Government Buying Standards for transport, NHS Digital’s Hospital Episode Statistics, Department for Environment, Food and Rural Affairs’ Daily Air Quality Index, Chronic heart failure in adults: diagnosis and management, Asthma: diagnosis, monitoring and chronic asthma management, Hypertension in adults: diagnosis and management, The Department for Environment, Food and Rural Affairs’ Daily Air Quality Index, Lung reduction volume surgery for advanced emphysema, serum natriuretic peptide measurement in the NICE Pathway on diagnosing chronic heart failure, restrictions and precautions for using fluoroquinolone antibiotics, advice for restrictions and precautions for using fluoroquinolone antibiotics, Oba Y et al. Relevant local strategies, such as the air quality action plan, commissioning and procurement strategy, core strategy, environment strategy, and health and wellbeing strategy. 1. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. (a sustained worsening of the person's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset: commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour), (this includes any previous, secure diagnosis of asthma or of atopy, a higher blood eosinophil count, substantial variation in, body mass index, airflow obstruction, dyspnoea and exercise capacity, Comité Européen de Normalisation (European Committee for Standardisation), (in the context of this guidance, the term 'cor pulmonale' has been adopted to define a clinical condition that is identified and managed on the basis of clinical features; this clinical syndrome of cor pulmonale includes patients who have right heart failure secondary to lung disease and those in whom the primary pathology is retention of salt and water, leading to the development of peripheral oedema), global initiative for chronic obstructive lung disease, (people who are not taking long-term oxygen therapy and who have a mean PaO, Medicines and Healthcare Products Regulatory Agency, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, (here, the term theophylline refers to slow-release formulations of the drug), Acute coronary syndromes: early management, Anaphylaxis: assessment and referral after emergency treatment, Anaemia management in people with chronic kidney disease, Hyperphosphataemia in chronic kidney disease, Sickle cell disease: acute painful episode, Genomic biomarker-based treatment for solid tumours, Metastatic malignant disease of unknown primary origin, Suspected cancer recognition and referral, Acute coronary syndromes: secondary prevention and rehabilitation, Cardiovascular disease: identifying and supporting people most at risk of dying early, Prophylaxis against infective endocarditis, Chronic fatigue syndrome myalgic encephalomyelitis, Diabetes and other endocrine, nutritional and metabolic conditions, Endocrine, nutritional and metabolic conditions, Lifestyle weight management services for overweight or obese adults, Lifestyle weight management services for overweight or obese children and young people, Dyspepsia and gastro-oesophageal reflux disease, Surgical management of otitis media with effusion in children, Preventing sexually transmitted infections and under-18 conceptions, Intrapartum care for women with existing medical conditions, Intrapartum care for women with obstetric complications, Developmental follow-up of children and young people born preterm, Specialist neonatal respiratory care in preterm babies, Antenatal care for uncomplicated pregnancies, Pregnancy and complex social factors: service provision, Urinary incontinence and pelvic organ prolapse in women, Antimicrobial prescribing for common infections, Bites and stings – antimicrobial prescribing, Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing, Cellulitis and erysipelas – antimicrobial prescribing, Self-limiting respiratory tract and ear infections – antibiotic prescribing, Bacterial meningitis and meningococcal septicaemia in under 16s, Prevention and control of healthcare-associated infections, Antisocial behaviour and conduct disorders in children and young people, Obsessive-compulsive disorder and body dysmorphic disorder, Attachment difficulties in children and young people, Common mental health disorders in primary care, Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset, Harmful sexual behaviour among children and young people, Health of people in the criminal justice system, Learning disabilities and behaviour that challenges, Mental health problems in people with learning disabilities, Coexisting severe mental illness and substance misuse: assessment and management in healthcare settings, Rehabilitation for adults with complex psychosis, Service user experience in adult mental health services, Transition between community or care home and inpatient mental health settings, Social care for older people with multiple long-term conditions, Urinary incontinence in neurological disease, Oral health improvement for local authorities and their partners, Community pharmacies: promoting health and wellbeing, Vitamin D: supplement use in specific population groups, Mental wellbeing and independence in older people, Social and emotional wellbeing for children and young people, Smokeless tobacco cessation: South Asian communities, Smoking: tobacco harm-reduction approaches, End of life care for people with life-limiting conditions, Looked-after babies, children and young people, Transition from children's to adults' services, Care and support of people growing older with learning disabilities, Excess winter deaths and illnesses associated with cold homes, Coexisting severe mental illness and substance misuse: community health and social care services, People’s experience in adult social care services, Service delivery, organisation and staffing, Emergency and acute medical care in over 16s: service delivery and organisation, Safe staffing for nursing in adult inpatient wards in acute hospitals, Managing medicines for people receiving social care in the community, Transition between inpatient hospital settings and community or care home settings for adults with social care needs, Opioids for pain relief in palliative care, Safe midwifery staffing for maternity settings, Controlled drugs: safe use and management, Managing long-term sickness absence and capability to work, Workplace health: policy and management practices, Chronic obstructive pulmonary disease – everything NICE says in an interactive flowchart, Chronic obstructive pulmonary disease overview, Antibiotics for treating exacerbations of COPD, Exacerbations of COPD: treatments only delivered in hospital, Pulmonary rehabilitation for stable COPD and exercise limitation, Pulmonary rehabilitation after an acute exacerbation, Hospital discharge care bundle (placeholder), Reducing emissions from public sector vehicle fleets, Advice for people with chronic respiratory or cardiovascular conditions, Accident prevention (see unintentional injuries among under-15s), Acute hospitals (adult inpatient wards), safe staffing for nursing, Acute myocardial infarction (see acute coronary syndromes: early management), ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-STEMI (see acute coronary syndromes: early management), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), STEMI (see acute coronary syndromes: early management), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Unstable angina (see acute coronary syndromes: early management), Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, Chronic obstructive pulmonary disease in adults, Air pollution: outdoor air quality and health, assess and reduce the environmental impact of implementing NICE recommendations, Chronic obstructive pulmonary disease in over 16s: diagnosis and management, Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing, Roflumilast for treating chronic obstructive pulmonary disease, Electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease, Bronchoscopic thermal vapour ablation for upper-lobe emphysema, Endobronchial valve insertion to reduce lung volume in emphysema, Insertion of endobronchial nitinol coils to improve lung function in emphysema, Living-donor lung transplantation for end-stage lung disease, Lung volume reduction surgery for advanced emphysema, Procalcitonin testing for diagnosing and monitoring sepsis (ADVIA Centaur BRAHMS PCT assay, BRAHMS PCT Sensitive Kryptor assay, Elecsys BRAHMS PCT assay, LIAISON BRAHMS PCT assay and VIDAS BRAHMS PCT assay), Chronic obstructive pulmonary disease: fluticasone furoate, umeclidinium and vilanterol (Trelegy), Chronic obstructive pulmonary disease: beclometasone, formoterol and glycopyrronium (Trimbow), Chronic obstructive pulmonary disease: tiotropium/olodaterol (Spiolto Respimat), Chronic obstructive pulmonary disease: aclidinium/formoterol, Chronic obstructive pulmonary disease: olodaterol, Chronic obstructive pulmonary disease: umeclidinium inhaler (Incruse), Chronic obstructive pulmonary disease: umeclidinium/vilanterol combination inhaler (Anoro Ellipta), Chronic obstructive pulmonary disease: beclometasone/formoterol (Fostair), Chronic obstructive pulmonary disease: indacaterol/glycopyrronium (Ultibro Breezhaler), Chronic obstructive pulmonary disease: fluticasone furoate plus vilanterol, Chronic obstructive pulmonary disease: glycopyrronium bromide, Chronic obstructive pulmonary disease: aclidinium bromide, myCOPD for self-management of chronic obstructive pulmonary disease, PulmoVista 500 for monitoring ventilation in critical care, Video laryngoscopes to help intubation in people with difficult airways, myAIRVO2 for the treatment of chronic obstructive pulmonary disease, VIDAvision for lung volume analysis in emphysema, Nasal Alar SpO2 sensor for monitoring oxygen saturation by pulse oximetry, Needle-free arterial non-injectable connector, chronic obstructive pulmonary disease in adults quality standard, smoking: supporting people to stop quality standard, air pollution: outdoor air quality and health quality standard, Royal College of Physicians’ National COPD Audit Programme, Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 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