a) Level of awareness among children, young people and adults with chronic respiratory or cardiovascular conditions on what to do when outdoor air quality is poor. 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. 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. All tiers of local government including county, district and unitary authorities, as well as regional bodies and transport authorities. 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. Numerator – the number in the denominator who have their inhaler technique assessed at the start of treatment. It also states that group behavioural support involves scheduled meetings in which people who smoke receive information, advice and encouragement and some form of behavioural intervention (for example, cognitive behavioural therapy). 1.2.1 When prescribing an antibiotic for an acute exacerbation of COPD, follow table 1 for adults aged 18 years and over. 25 July 2019 Updated on publication of the update of chronic obstructive pulmonary disease in over 16s: diagnosis and management (NICE guideline NG115). A placeholder statement indicates the need for evidence-based guidance to be developed in this area. NICE does recommend that, when using triple therapy for breathlessness, there should be a review after 3 months to check efficacy, but in … COPD Exacerbations: An Official ERS/ATS Clinical Practice Guideline. 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. PCRS and other organisations advised that this omission would render the guideline out of date on Many exacerbations are not caused by bacterial infections so will not respond to antibiotics. Denominator – the number of people with COPD prescribed an inhaler who have had their inhaler changed. Commonly reported symptoms are: worsening breathlessness, cough, increased sputum production and change in the colour of the sputum. [, Non-invasive ventilation should be given once it is recognised that a person is not responding to 1 hour of optimal medical therapy. Some people with COPD may not be well enough to attend a pulmonary rehabilitation programme within 4 weeks of an acute exacerbation, may not have attended hospital after an acute exacerbation of COPD or may not have been admitted to hospital after their exacerbation of COPD. respiratory rate increase or heart rate increase 20% above baseline. The consensus view on the role of ICS in COPD is in the reduction of exacerbations and not in the treatment of breathlessness. Short of breath when hurrying or walking up a slight hill. 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. Numerator – the number in the denominator who are referred to a pulmonary rehabilitation programme. Increased cough; increased sputum purulence and increased sputum volume. a) Evidence of local arrangements and written clinical protocols to ensure that people with COPD who are prescribed an inhaler have their technique assessed at the start of treatment and then regularly during their treatment. c) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after a change in treatment. 6 August 2015 Smoking: supporting people to stop (NICE quality standard 43) added. Numerator – the number in the denominator who had their inhaler technique assessed after an acute exacerbation. Exacerbations of COPD can be associated with the following symptoms: 1. Numerator – the number in the denominator that result in the person attending a pulmonary rehabilitation programme. Assessing proposals to minimise and mitigate road-traffic-related air pollution will help to ensure they are robust and evidence based. 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. Lesbian, gay, bisexual and transgender (LGBT) groups have higher smoking prevalence rates than the general population, and as such, services should be accessible and commissioned to address this need. The exacerbations of copd path for the chronic obstructive pulmonary disease pathway. d) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after an acute exacerbation. Denominator – the number of planning applications for major developments granted permission. People receiving emergency oxygen for an acute exacerbation of chronic obstructive pulmonary disease (COPD) have their oxygen saturation levels maintained between 88% and 92%. Programmes comprise individualised exercise programmes and education, and: Pulmonary rehabilitation is not suitable for people with unstable cardiac disease, locomotor or neurological difficulties precluding exercise such as severe arthritis or peripheral vascular disease, and people in a terminal phase of an illness or with significant cognitive or psychiatric impairment. 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. Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Denominator – the number of people with COPD prescribed an inhaler for more than 12 months. 1,2, First-choice oral antibiotics (empirical treatment or guided by most recent sputum culture and susceptibilities), 500 mg three times a day for 5 days (see BNF for dosage in severe infections), 200 mg on first day, then 100 mg once a day for 5‑day course in total (see BNF for dosage in severe infections), Second-choice oral antibiotics (no improvement in symptoms on first choice taken for at least 2 to 3 days; guided by susceptibilities when available), Use alternative first choice (from a different class), Alternative choice oral antibiotics (if person at higher risk of treatment failure 6 Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible. 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. Adapted from Fletcher CM, Elmes PC, Fairbairn MB et al. By publicising their approach, public sector organisations can encourage organisations in other sectors to take action to reduce emissions from their vehicle fleets. 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. Children and young people aged 5 to 16 to contact a healthcare professional for a review if their asthma control deteriorates. BMJ 2010; 341:c5462. 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. Increased cough. This statement is linked to statement 2, because advice on how to stop may include a referral to an evidence-based smoking cessation service. 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 to ensure that people who smoke are offered a referral to an evidence-based smoking cessation service. 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. 3 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. 1.2.2 Give oral antibiotics first line if the person can take oral medicines, and the severity of their exacerbation does not require intravenous antibiotics. 1.2.2 Give oral antibiotics first line if the person can take oral medicines, and the severity of their exacerbation does not require intravenous antibiotics. 2. Pathway created: May 2011 Last updated: August 2020. 1. Denominator – the number of people identified as smokers in any healthcare setting. 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. Everything NICE has said on diagnosing and managing chronic obstructive pulmonary disease in people aged 16 and over in an interactive flowchart. There is currently a lack of evidence-based guidance about the details that should be included in these care bundles. 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. Post-bronchodilator spirometry is used to identify abnormalities in lung volumes and air flow. Numerator – the number in the denominator who had their inhaler technique assessed after a change in treatment. Not troubled by breathlessness except on strenuous exercise. 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