Evidence

Surveillance report 2016 – Chronic obstructive pulmonary disease in over 16s: diagnosis and management (2010) NICE guideline CG101

Surveillance decision

Surveillance decision

We will plan an update of the guideline.

Reason for the decision

We found 498 new studies through surveillance of this guideline. New evidence that could affect recommendations was identified. Topic experts, including those who helped to develop the guideline, advised us about whether the following sections of the guideline should be updated:

Diagnosing COPD

  • Is routine assessment using multidimensional severity assessment indices (e.g. BODE) more predictive of outcomes compared with FEV1 alone?

  • What are the most appropriate tests in a patient with suspected COPD to confirm the diagnosis?

Managing stable COPD

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists (LAMAs) plus long‑acting beta2 agonists (LABAs) compared to long-acting muscarinic antagonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus long‑acting beta2 agonists compared to long‑acting muscarinic antagonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus long‑acting beta2 agonists compared to long‑acting beta2 agonists plus inhaled corticosteroids (ICSs) in the management of people with stable COPD?

  • Which patients with stable COPD should be treated with long‑acting anticholinergics? How should the effects of this treatment be assessed?

  • What is the role of antibiotic therapy in patients with stable COPD?

  • In patients with stable COPD what therapies can be used to manage pulmonary hypertension?

  • Do self-management plans and patient education affect concordance with treatment and improve outcomes in patients with stable COPD?

  • What is the role of oxygen therapy in patients with stable COPD?

  • In patients with stable COPD, what are the referral criteria for lung surgery?

Management of exacerbations of COPD

  • What are the factors known to cause exacerbations of COPD?

New evidence was identified for all the above questions which may impact on recommendations. Please see appendix A for further details.

Decision: These review questions should be updated.

Managing stable COPD

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists compared with long‑acting beta2 agonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting beta2 agonists plus inhaled corticosteroids compared to long‑acting beta2 agonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting beta2 agonists plus inhaled corticosteroids compared to long‑acting muscarinic antagonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus inhaled corticosteroids compared to long‑acting beta2 agonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus inhaled corticosteroids compared to long‑acting muscarinic antagonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus long‑acting beta2 agonists plus inhaled corticosteroids compared to long‑acting beta2 agonists plus inhaled corticosteroids in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus long‑acting beta2 agonists plus inhaled corticosteroids compared to long‑acting muscarinic antagonists alone in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists compared to short‑acting muscarinic antagonists in the management of people with stable COPD?

  • What is the clinical and cost effectiveness of long‑acting muscarinic antagonists plus long‑acting beta2 agonists plus inhaled corticosteroids compared to long‑acting beta2 agonists plus long‑acting muscarinic antagonists in the management of people with stable COPD?

No new evidence was identified which indicated a need to update the above‑mentioned clinical questions; however, they should be updated because they are directly related to other clinical questions in the pathway for inhaled bronchodilator therapy that have been identified for update. The pathway for inhaled therapy is considered as a whole therefore if an individual component of the pathway is amended it is likely that this will impact on other related components.

Decision: These review questions should be updated.

Managing stable COPD

  • Which patients with stable COPD should be treated with inhaled steroids? How should the effects of this treatment be assessed?

  • What are the most appropriate delivery systems for giving inhaled therapy to patients with stable COPD?

Decision: These review questions should not be updated; however, footnotes highlighting safety considerations will be added to the guideline. This is due to:

  • A Drug Safety Update, published in 2010, outlining psychological and behavioural side effects associated with inhaled steroids.

  • A Drug Safety Update, published in February 2015, outlining a number of safety considerations when prescribing tiotropium delivered via Respimat or Handihaler to patients with certain cardiac conditions.

Other clinical areas

We also found new evidence that was not thought to have an effect on current recommendations. This evidence related to symptoms; spirometry; further investigations; reversibility testing; identification of early disease; referral for specialist advice; smoking cessation; delivery systems used to treat patients with stable COPD; oral therapy; pulmonary rehabilitation; vaccination and anti‑viral therapy; alpha‑1 antitrypsin replacement therapy; multi‑disciplinary assessment; assessment of need for hospital treatment; hospital‑at‑home and assisted‑discharge schemes; non‑invasive ventilation and discharge planning.

Overall decision

After considering all the new evidence and views of topic experts, we decided that an update is necessary for this guideline.

See how we made the decision for further information.


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