Intended for healthcare professionals

Practice Guidelines

Chronic obstructive pulmonary disease: diagnosis and management: summary of updated NICE guidance

BMJ 2019; 366 doi: (Published 29 July 2019) Cite this as: BMJ 2019;366:l4486
  1. Nicholas S Hopkinson, reader in respiratory medicine and honorary consultant physician1,
  2. Andrew Molyneux, consultant physician in respiratory and medicine and chair of Guideline Committee2,
  3. Joshua Pink, technical advisor3,
  4. Marie C Harrisingh, senior technical analyst3
  5. on behalf of the Guideline Committee (GC)
  1. 1National Heart and Lung Institute, Imperial College, London, UK
  2. 2Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, UK
  3. 3National Institute for Health and Care Excellence, London, UK
  1. Correspondence to M Harrisingh marie.harrisingh{at}

What you need to know

  • The interventions of highest value for people with chronic obstructive pulmonary disease (COPD) are treatment and support to stop smoking, pulmonary rehabilitation in patients limited by breathlessness, and flu vaccination

  • Choice of initial long acting inhaled therapies depends on the presence or absence of asthmatic features/features which suggest steroid responsiveness

  • Self management plans improve quality of life and reduce hospital admissions

  • Treatment for acute exacerbations of COPD, including rescue packs for patients to use for self management, should be for five days only

  • Only prescribe home oxygen for people who are hypoxic and do not smoke currently

There are 1.3 million people in the UK with a diagnosis of chronic obstructive pulmonary disease (COPD) and the condition is responsible for considerable morbidity and mortality.1 COPD is also a common cause of hospital admission. NHS England has now recognised respiratory disease as a priority area in the Long Term Plan,2 but Royal College of Physicians COPD Audits3 identify substantial deficiencies across the healthcare system, including marked under-provision of pulmonary rehabilitation, flu vaccination, and smoking cessation treatment.

This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).10 The updated areas are mainly concerned with the management of stable COPD and include self management and education, assessment for lung volume reduction procedures, and home oxygen use. This article focuses on the newly updated sections, with reference to older recommendations where they are particularly important or needed for context.

Effective COPD management pathways require an integrated approach across primary and secondary care and involve a multidisciplinary team of health professionals. The guidance focuses on the need to ensure that good quality care is delivered wherever patients are seen. Specialist care, whether delivered in a hospital or community setting, may be indicated for people …

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