Management of stable chronic obstructive pulmonary disease in primary and secondary care: summary of updated NICE guidance

Over three million people in the United Kingdom are estimated to have chronic obstructive pulmonary disease (COPD), of whom more than two million remain undiagnosed, representing the so called “missing millions” alluded to in the draft national strategy for COPD.1 2 3 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of stable chronic obstructive pulmonary disease in primary and secondary care,4 which update the COPD guidelines first published by NICE in 2004.5 The summary contains the most important recommendations relating to new diagnostic criteria for COPD, changes to the classification of severity of airflow obstruction, the need for multidimensional severity assessment, a new algorithm for inhaled drug treatments (figure⇓), and the value of early pulmonary rehabilitation. Algorithm for use of inhaled therapies NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the updated recommendations are given in italic in square brackets. ### Diagnosing COPD