Chronic obstructive pulmonary disease in over 16s: diagnosis and management

Reasons for the decision

This exceptional review examined any impact on NICE's guideline on COPD in over 16s following the publication of a National Institute for Health Research funded trial on C-reactive protein (CRP) testing to guide antibiotic prescribing for COPD exacerbations.

This randomised controlled trial investigated the use of point of care testing (POCT) in GP practices in England and Wales for people with a diagnosis of COPD experiencing an acute exacerbation. Fewer patients in the CRP guided group received antibiotic prescriptions both at the initial consultation and during the 4-week trial period, compared with those in the non-CRP guided group. Additional studies, including a Cochrane review, also showed reduced antimicrobial prescribing in some groups but studies were small and heterogeneous and might not represent the general population of COPD patients. Overall, topic experts considered that the study has promising preliminary results, but further studies are needed to clarify the role of POCT in the management of COPD exacerbations; funding and feasibility were noted as concerns for wider adoption in general practice.