3 People who may be at a higher risk of treatment failure include people who have had repeated courses of antibiotics, a previous or current sputum culture with resistant bacteria, or people at higher risk of developing complications. [Adapted from. Stoller JK. Malaise. a) Hospital admissions for acute exacerbation. 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. [. a) Evidence that healthcare professionals carrying out routine health appointments with children, young people and adults with chronic respiratory or cardiovascular conditions are aware of the advice they should provide on what to do when outdoor air quality is poor. Closing external doors and windows facing a busy street at times when traffic is heavy or congested to help stop highly polluted air getting in. Providing advice to children, young people and adults with chronic respiratory or cardiovascular conditions (and their families or carers, if appropriate) at routine health appointments will support self-management, improve their awareness of how to protect themselves when outdoor air quality is poor and prevent their condition escalating. 1.1.6 Reassess people with an acute exacerbation of COPD if their symptoms worsen rapidly or significantly at any time, taking account of: other possible diagnoses, such as pneumonia, any symptoms or signs suggesting a more serious illness or condition, such as cardiorespiratory failure or sepsis. The 2010 NICE guidelines [ 5] concluded that, in the absence of significant contraindications, oral corticosteroids should be used in conjunction with other therapies in all patients admitted to hospital with an exacerbation of COPD and considered in patients in the community who have an exacerbation with a significant increase in breathlessness that interferes with daily activities. 6, 500 mg three times a day (see BNF for dosage in severe infections), 960 mg twice a day (see BNF for dosage in severe infections), 4.5 g three times a day (see BNF for dosage in severe infections), Consult local microbiologist; guided by susceptibilities. To ensure early diagnosis, spirometry should be done in primary care when a person presents with a risk factor for COPD (which is usually smoking) and one or more symptoms of COPD. There should be a discussion about risks and benefits of using NRT with young people aged 12–17 and pregnant or breastfeeding women. Local authorities should ensure that they assess the impact on vulnerable groups if local charges on certain classes of vehicle in clean air zones are proposed. 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). NICE has produced resources to help implement its guidance on: NICE has written information for the public on each of the following topics. People who smoke are more likely to stop smoking if they are offered a combination of interventions, with combined behavioural support and pharmacotherapy the most likely to be successful. Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT. People with stable chronic obstructive pulmonary disease (COPD) and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need long-term oxygen therapy (LTOT). 1 See the British national formulary (BNF) for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment, and administering intravenous antibiotics. b) Overall fuel consumption for public sector vehicle fleets. Celli BR, MacNee W, Agusti A et al. They should do so 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. Increased cough; increased sputum purulence and increased sputum volume. People with COPD and a persistent resting stable oxygen saturation of 92% or less should be assessed for their suitability for LTOT, which can improve survival, pulmonary haemodynamics, polycythaemia and neuropsychological health. Numerator – the number in the denominator who have their inhaler technique assessed at the start of treatment. 6 August 2015 Smoking: supporting people to stop (NICE quality standard 43) added. Practitioners should be aware that some pregnant women find it difficult to say that they smoke because the pressure not to smoke during pregnancy is so intense. b) Rate of hospital attendance or admission for respiratory or cardiovascular exacerbations. (a sustained worsening of the person's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset: commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour), (this includes any previous, secure diagnosis of asthma or of atopy, a higher blood eosinophil count, substantial variation in, body mass index, airflow obstruction, dyspnoea and exercise capacity, Comité Européen de Normalisation (European Committee for Standardisation), (in the context of this guidance, the term 'cor pulmonale' has been adopted to define a clinical condition that is identified and managed on the basis of clinical features; this clinical syndrome of cor pulmonale includes patients who have right heart failure secondary to lung disease and those in whom the primary pathology is retention of salt and water, leading to the development of peripheral oedema), global initiative for chronic obstructive lung disease, (people who are not taking long-term oxygen therapy and who have a mean PaO, Medicines and Healthcare Products Regulatory Agency, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, (here, the term theophylline refers to slow-release formulations of the drug), Acute coronary syndromes: early management, Anaphylaxis: assessment and referral after emergency treatment, Anaemia management in people with chronic kidney disease, Hyperphosphataemia in chronic kidney disease, Sickle cell disease: acute painful episode, Genomic biomarker-based treatment for solid tumours, Metastatic malignant disease of unknown primary origin, Suspected cancer recognition and referral, Acute coronary syndromes: secondary prevention and rehabilitation, Cardiovascular disease: identifying and supporting people most at risk of dying early, Prophylaxis against infective endocarditis, Chronic fatigue syndrome myalgic encephalomyelitis, Diabetes and other endocrine, nutritional and metabolic conditions, Endocrine, nutritional and metabolic conditions, Lifestyle weight management services for overweight or obese adults, Lifestyle weight management services for overweight or obese children and young people, Dyspepsia and gastro-oesophageal reflux disease, Surgical management of otitis media with effusion in children, Preventing sexually transmitted infections and under-18 conceptions, Intrapartum care for women with existing medical conditions, Intrapartum care for women with obstetric complications, Developmental follow-up of children and young people born preterm, Specialist neonatal respiratory care in preterm babies, Antenatal care for uncomplicated pregnancies, Pregnancy and complex social factors: service provision, Urinary incontinence and pelvic organ prolapse in women, Antimicrobial prescribing for common infections, Bites and stings – antimicrobial prescribing, Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing, Cellulitis and erysipelas – antimicrobial prescribing, Self-limiting respiratory tract and ear infections – antibiotic prescribing, Bacterial meningitis and meningococcal septicaemia in under 16s, Prevention and control of healthcare-associated infections, Antisocial behaviour and conduct disorders in children and young people, Obsessive-compulsive disorder and body dysmorphic disorder, Attachment difficulties in children and young people, Common mental health disorders in primary care, Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset, Harmful sexual behaviour among children and young people, Health of people in the criminal justice system, Learning disabilities and behaviour that challenges, Mental health problems in people with learning disabilities, Coexisting severe mental illness and substance misuse: assessment and management in healthcare settings, Rehabilitation for adults with complex psychosis, Service user experience in adult mental health services, Transition between community or care home and inpatient mental health settings, Social care for older people with multiple long-term conditions, Urinary incontinence in neurological disease, Oral health improvement for local authorities and their partners, Community pharmacies: promoting health and wellbeing, Vitamin D: supplement use in specific population groups, Mental wellbeing and independence in older people, Social and emotional wellbeing for children and young people, Smokeless tobacco cessation: South Asian communities, Smoking: tobacco harm-reduction approaches, End of life care for people with life-limiting conditions, Looked-after babies, children and young people, Transition from children's to adults' services, Care and support of people growing older with learning disabilities, Excess winter deaths and illnesses associated with cold homes, Coexisting severe mental illness and substance misuse: community health and social care services, People’s experience in adult social care services, Service delivery, organisation and staffing, Emergency and acute medical care in over 16s: service delivery and organisation, Safe staffing for nursing in adult inpatient wards in acute hospitals, Managing medicines for people receiving social care in the community, Transition between inpatient hospital settings and community or care home settings for adults with social care needs, Opioids for pain relief in palliative care, Safe midwifery staffing for maternity settings, Controlled drugs: safe use and management, Managing long-term sickness absence and capability to work, Workplace health: policy and management practices, Chronic obstructive pulmonary disease – everything NICE says in an interactive flowchart, Chronic obstructive pulmonary disease overview, Antibiotics for treating exacerbations of COPD, Exacerbations of COPD: treatments only delivered in hospital, Pulmonary rehabilitation for stable COPD and exercise limitation, Pulmonary rehabilitation after an acute exacerbation, Hospital discharge care bundle (placeholder), Reducing emissions from public sector vehicle fleets, Advice for people with chronic respiratory or cardiovascular conditions, Accident prevention (see unintentional injuries among under-15s), Acute hospitals (adult inpatient wards), safe staffing for nursing, Acute myocardial infarction (see acute coronary syndromes: early management), ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-STEMI (see acute coronary syndromes: early management), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), STEMI (see acute coronary syndromes: early management), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Unstable angina (see acute coronary syndromes: early management), Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, Chronic obstructive pulmonary disease in adults, Air pollution: outdoor air quality and health, assess and reduce the environmental impact of implementing NICE recommendations, Chronic obstructive pulmonary disease in over 16s: diagnosis and management, Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing, Roflumilast for treating chronic obstructive pulmonary disease, Electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease, Bronchoscopic thermal vapour ablation for upper-lobe emphysema, Endobronchial valve insertion to reduce lung volume in emphysema, Insertion of endobronchial nitinol coils to improve lung function in emphysema, Living-donor lung transplantation for end-stage lung disease, Lung volume reduction surgery for advanced emphysema, Procalcitonin testing for diagnosing and monitoring sepsis (ADVIA Centaur BRAHMS PCT assay, BRAHMS PCT Sensitive Kryptor assay, Elecsys BRAHMS PCT assay, LIAISON BRAHMS PCT assay and VIDAS BRAHMS PCT assay), Chronic obstructive pulmonary disease: fluticasone furoate, umeclidinium and vilanterol (Trelegy), Chronic obstructive pulmonary disease: beclometasone, formoterol and glycopyrronium (Trimbow), Chronic obstructive pulmonary disease: tiotropium/olodaterol (Spiolto Respimat), Chronic obstructive pulmonary disease: aclidinium/formoterol, Chronic obstructive pulmonary disease: olodaterol, Chronic obstructive pulmonary disease: umeclidinium inhaler (Incruse), Chronic obstructive pulmonary disease: umeclidinium/vilanterol combination inhaler (Anoro Ellipta), Chronic obstructive pulmonary disease: beclometasone/formoterol (Fostair), Chronic obstructive pulmonary disease: indacaterol/glycopyrronium (Ultibro Breezhaler), Chronic obstructive pulmonary disease: fluticasone furoate plus vilanterol, Chronic obstructive pulmonary disease: glycopyrronium bromide, Chronic obstructive pulmonary disease: aclidinium bromide, myCOPD for self-management of chronic obstructive pulmonary disease, PulmoVista 500 for monitoring ventilation in critical care, Video laryngoscopes to help intubation in people with difficult airways, myAIRVO2 for the treatment of chronic obstructive pulmonary disease, VIDAvision for lung volume analysis in emphysema, Nasal Alar SpO2 sensor for monitoring oxygen saturation by pulse oximetry, Needle-free arterial non-injectable connector, chronic obstructive pulmonary disease in adults quality standard, smoking: supporting people to stop quality standard, air pollution: outdoor air quality and health quality standard, Royal College of Physicians’ National COPD Audit Programme, Chronic obstructive pulmonary disease in over 16s: diagnosis and management. a) Hospital admissions for acute exacerbations. 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