The provision of oxygen therapy for continuous use at home, usually given for at least 15 hours during the day or night. Proportion of people who seek support to stop smoking and who agree to take pharmacotherapy who receive a full course. 1.1.2 Consider an antibiotic (see the recommendations on choice of antibiotic) for people with an acute exacerbation of COPD, but only after taking into account: the severity of symptoms, particularly sputum colour changes and increases in volume or thickness beyond the person's normal day-to-day variation, whether they may need to go into hospital for treatment (see the NICE guideline on COPD in over 16s), previous exacerbation and hospital admission history, and the risk of developing complications, previous sputum culture and susceptibility results. Evidence of local arrangements and written clinical protocols to ensure that people with stable COPD and a persistent resting stable oxygen saturation level of 92% or less have their arterial blood gases measured to assess whether they need LTOT. An individual patient assessment should be carried out before choosing the most appropriate device for delivery of inhaled therapy. Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT. A diagnosis of COPD is confirmed by post-bronchodilator spirometry. a) Hospital admission for acute exacerbation. People are asked if they smoke by their healthcare practitioner, and those who smoke are offered advice on how to stop. the winning and working of minerals or the use of land for mineral-working deposits, the number of dwelling houses to be provided is 10 or more or, the development is to be carried out on a site having an area of 0.5 hectares or more and the number of dwelling houses is not known, the provision of a building or buildings where the floor space to be created by the development is 1,000 square metres or more or. Numerator – the number in the denominator that result in the person completing a pulmonary rehabilitation programme. Numerator – the number of people in the denominator who are assessed for carbon monoxide levels 4 weeks after the quit date. are at least 6 weeks in duration and include a minimum of twice-weekly supervised sessions, include supervised, individually tailored and prescribed, progressive exercise training including both aerobic and resistance training. 11 June 2019 Bronchoscopic thermal vapour ablation for upper-lobe emphysema (NICE interventional procedures guidance 652) added to. “The latest NICE guidance on COPD has managed to maintain a simplicity that makes sense to most clinicians. NICE d) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will develop buildings and spaces to reduce exposure to air pollution. It is usually delivered through a mask that covers the nose or a mask covering the nose and the mouth. b) Overall fuel consumption for public sector vehicle fleets. Numerator – the number in the denominator who have their inhaler technique assessed at the start of treatment. a) Proportion of zero- or ultra-low-emission vehicles in public sector vehicle fleets. Denominator – the number of people with COPD prescribed an inhaler who have had their inhaler changed. See the evidence and committee discussion on choice of antibiotic and antibiotic course length. Exacerbations of COPD •Responsible for winter bed pressures in the UK •Cost the NHS over £500 million annually1 •Over 1.5 million GP consultations annually in UK related to exacerbation1 1. Pharmacotherapies for smoking cessation are nicotine replacement therapy (NRT), varenicline or bupropion. Denominator – the number of referrals of people with stable COPD and exercise limitation due to breathlessness to pulmonary rehabilitation programmes. a) Frequency of non-invasive ventilation due to oxygen toxicity. [, An oxygen saturation (measured with a pulse oximeter) that is persistently 92% or less when the person is in a chronic stable state and is at rest (is not, and has not recently, been exercising). See the NICE guideline on COPD in over 16s for other recommendations on preventing and managing an acute exacerbation of COPD, including self-management. Public sector organisations can extend their impact by commissioning transport or fleet services from organisations that reduce emissions from their vehicle fleets to address air pollution. Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post-bronchodilator spirometry. Local planning authorities assess proposals to minimise and mitigate road-traffic-related air pollution in planning applications for major developments. 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. NICE guidance recommends that young people aged 12–17 who smoke should be offered information, advice and support on how to stop smoking and be encouraged to use evidence-based smoking cessation services. Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. An exacerbation is a sustained worsening of a person’s symptoms from their usual stable state and which is beyond usual day-to-day variations and acute in onset. 8 Table 3 highlights the factors … Or FEV1 below 50% with respiratory failure. c) Proportion of people with COPD prescribed an inhaler who have their inhaler technique assessed after a change in treatment. A guidance on managing exacerbations is expected by Dec 2018. the person becomes systemically very unwell. The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. 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. 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