Guidance

Update information

Update information

July 2019: We have reviewed evidence on inhaled triple therapy for managing stable COPD, and oral corticosteroids for managing exacerbations.

Recommendations are marked [2019] if the evidence has been reviewed.

In recommendations ending [2004], [2004, amended 2018], [2010], [2010, amended 2018] or [2018], we have not reviewed the evidence.

December 2018: This guideline is an update of NICE guideline CG101 (published June 2010) and replaces it.

We have reviewed evidence on diagnosis and prognosis, inhaled combination therapies, prophylactic antibiotics, oxygen therapy, managing pulmonary hypertension and cor pulmonale, lung surgery and lung volume reduction procedures, education, self-management and telehealth monitoring for people with chronic obstructive pulmonary disease (COPD). These recommendations are marked [2018].

We have also made some changes without an evidence review:

  • The 'working definition of COPD' has been deleted, because it was not based on an evidence review and it was unclear whether the thresholds it used were correct and up to date.

  • Recommendation 1.1.4 had an extra bullet point on disease progression added in, based on the information in table 5.

  • Recommendation 1.1.11 has been amended to signpost to the more recent European Respiratory Journal GLI 2012 reference values for spirometry.

  • In recommendation 1.1.25:

    • the order of investigations was changed, based on the committee's experience, to put the most important factors nearer the top

    • health status was removed from the list and replaced by a number of separate factors (frailty, severity and frequency of exacerbations, hospital admissions, multimorbidity and symptom burden)

    • the cor pulmonale entry was expanded to include chronic hypoxia, which replaced partial pressure of oxygen in arterial blood (PaO2)

    • long-term oxygen therapy and/or home non-invasive ventilation (NIV) was added to the list

    • smoking status was added to the list.

  • The first note under table 3 was made into a recommendation, to make it more prominent.

  • A footnote was added to recommendation 1.2.9 to refer to relevant safety information from the Medicines and Healthcare products Regulatory Agency (MHRA) about inhaled corticosteroids that was posted after the 2010 COPD guideline update.

  • Recommendations on inhaled therapy that don't fit in the new treatment pathway have been deleted.

  • A footnote was added to recommendation 1.2.11 to refer to relevant safety information from the MHRA about tiotropium inhalers that was posted after the 2010 COPD guideline update.

  • Recommendation 1.2.27 has been amended so that it no longer refers to wiping the mouthpiece, because this is not needed if it has been washed and allowed to dry.

  • Recommendation 1.2.99 has been amended to refer to 'positive expiratory pressure devices' instead of positive expiratory pressure masks.

  • Recommendation 1.2.100 was amended to refer to anxiety in the first sentence, to make it internally consistent.

  • The opening sentence of recommendation 1.3.3 was amended to make it clearer who this referred to.

  • Recommendation 1.3.36 has been amended to refer to 'positive expiratory pressure devices' instead of positive expiratory pressure masks.

These recommendations are marked [2004, amended 2018] or [2010, amended 2018].

Recommendations marked [2004] or [2010] last had an evidence review in 2004 or 2010. In some cases, minor changes have been made to the wording to bring the language and style up to date, without changing the meaning.

Minor changes since publication

October 2022: We added text to indicate that pulse oximetry may be less reliable in people with dark skin. We also added a link to the NHS patient safety alerton the risk of harm from inappropriate placement of pulse oximeter probes. See recommendations 1.2.56, 1.3.1, 1.3.2 and 1.3.28.

ISBN: 978-1-4731-3468-3