More severe degrees of acidosis, such as pH <7.25, have been used as a threshold for considering provision of invasive mechanical ventilation. During an exacerbation, people with COPD may experience a worsening of gas exchange in the lungs, which can lead to low blood oxygen levels. Numerator – the number of people in the denominator who are asked if they smoke by their healthcare practitioner. include a defined, structured education programme. 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. Children and young people aged 5 to 16 to contact a healthcare professional for a review if their asthma control deteriorates. Medical Research Council dyspnoea scale of breathlessness grade 3 and above. There's currently no cure for chronic obstructive pulmonary disease (COPD), but treatment can help slow the progression of the condition and control the symptoms. Denominator – the number of people with COPD prescribed an inhaler who have had an acute exacerbation. 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. 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. People with chronic obstructive pulmonary disease (COPD) who are prescribed an inhaler have their inhaler technique assessed when starting treatment and then regularly during treatment. Denominator – the number of people identified as smokers in any healthcare setting. b) Evidence of local processes to ensure that children, young people and adults with chronic respiratory or cardiovascular conditions attending routine health appointments are given advice on what to do when outdoor air quality is poor. CareOregon OHP COPD Treatment Pathway Oct 2020 ICS = inhaled corticosteroid. COPD treated with both pharmacotherapy and non-pharmacological management can improve symptoms and quality of life for patients at any stage of disease severity. Emergency oxygen is often given during the treatment of an exacerbation, either in the community, during transfer to hospital in an ambulance or while being assessed at hospital. Treatment for associated comorbidities (such as anxiety and depression). Denominator – the number of planning applications for major developments granted permission. Starting a pulmonary rehabilitation programme within 4 weeks of hospital discharge after an acute exacerbation reduces the short-term risk of hospital readmission, and improves the quality of life and the short-term exercise capacity of people with COPD. Identifying their approach to air pollution in the Local Plan, local transport plan and other key strategies will provide a clear framework for joined-up local action. A summary of further considerations relating to pharmacotherapy is provided in quality statement 4. b) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed at their annual review. VAT number 648 8121 18. [Expert consensus], Controlled oxygen therapy, nebulised bronchodilator therapy, systemic corticosteroids and antibiotics if indicated, in line with the NICE guideline. People have the right to be involved in discussions and make informed decisions about their care, as described in. b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary, community and secondary care services are trained and competent in teaching inhaler technique. [Adapted from. exposure to fumes, such as biomass fuels. a) Evidence of local arrangements and written clinical protocols to ensure that people aged over 35 years presenting with a risk factor and one or more symptoms of COPD have post-bronchodilator spirometry. 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. b) Rate of hospital attendance or admission for respiratory or cardiovascular exacerbations. Background: Increasing availability of therapeutic options for COPD may drive new treatment pathways. Bronchodilator therapy is usually delivered using a hand-held inhaler device. In later, more severe stages of COPD, oxygen tank therapy may need to be incorporated as a part of the pathway. Evidence of local arrangements to ensure that people who smoke are offered a referral to an evidence-based smoking cessation service. b) Proportion of referrals of people with stable COPD and exercise limitation due to breathlessness that result in the person attending a pulmonary rehabilitation programme. Clinical features. Considering people’s co-morbidities is essential for COPD treatment, as it is a better predictor of mortality than just considering frequency of COPD exacerbations. The guidelines for the diagnosis, treatment, and control of the coronavirus disease 2019 (COVID-19). 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 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. Denominator – the number of referrals of people with stable COPD and exercise limitation due to breathlessness to pulmonary rehabilitation programmes. a) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will address air pollution, including who is responsible for delivering key actions. This can be individual or group behavioural support. Citation Gundry S (2019) COPD 1: pathophysiology, diagnosis and prognosis. Spirometry should be performed by a healthcare professional who has had appropriate training and who has up-to-date skills. c) Evidence of local arrangements to ensure that primary care services providing post-bronchodilator spirometry are supported by quality control processes. Public sector organisations can extend their impact by commissioning transport or fleet services from organisations that reduce emissions from their vehicle fleets to address air pollution. Reducing emissions from public sector vehicle fleets will help to reduce road-traffic-related air pollution. 25 July 2019 Updated on publication of the update of chronic obstructive pulmonary disease in over 16s: diagnosis and management (NICE guideline NG115). [, Non-invasive ventilation should be given once it is recognised that a person is not responding to 1 hour of optimal medical therapy. The use of post-bronchodilator spirometry should be supported by quality control processes. Buildings can affect the way air pollutants are dispersed through street design and the resulting impact on air flow. 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. a) Hospital admissions for acute exacerbations. COPD has a substantial burden which is seen in both patient quality of life and healthcare costs. Treatment with a SABA as required may be continued in all stages of COPD. a) Proportion of people with stable COPD and exercise limitation due to breathlessness who are referred to a pulmonary rehabilitation programme. Proportion of people discharged from hospital after an acute exacerbation of COPD who start a pulmonary rehabilitation programme within 4 weeks of discharge. Public sector organisations reduce emissions from their vehicle fleets to address air pollution. In some people, uncontrolled oxygen therapy may reduce the depth and frequency of breathing, leading to a rise in blood carbon dioxide levels and a fall in the blood pH (acidosis). It is normally combined with pharmacotherapy. As initial inhaled therapy for COPD, a short-acting bronchodilator (SABA), or short-acting muscarinic antagonist (SAMA) for use as needed (to relieve breathlessness and … 2017, in the Cochrane Library, Anthonisen et al. The NHS RightCare Pathway for COPD has been developed in collaboration with NHS England’s National Clinical Director for Respiratory Services, the British Lung Foundation, the British Thoracic Society, Respiratory Futures, the Primary Care Respiratory Society (PCRS-UK), and the National COPD Audit Programme. Numerator – the number in the denominator that were given advice on what to do when outdoor air quality is poor. 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