Denominator – the number of people referred to an evidence-based smoking cessation service. 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. More than 3 million people died of COPD in 2012 accounting for 6% of all deaths globally. A placeholder statement indicates the need for evidence-based guidance to be developed in this area. a) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will address air pollution, including who is responsible for delivering key actions. 25 July 2017 Roflumilast for treating chronic obstructive pulmonary disease (NICE technology appraisal guidance 461) added to. Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post-bronchodilator spirometry. 3. NICE Bites No 115, February 2019, includes one topic: chronic obstructive pulmonary disease (COPD). : CD009764. The recommendations on assessment of a person with an acute exacerbation of COPD are largely based on the NICE clinical guidelines Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing [NICE, 2018a] and Chronic obstructive pulmonary disease in over 16s: diagnosis and management [NICE, 2019a], the clinical guidelines COPD-X: concise guide for primary care [Lung … They should do so in the context of local and national priorities for funding and developing services, and 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. A post bronchodilator ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) of less than 0.7 on spirometry confirms persistent airflow obstruction. Post-bronchodilator spirometry is used to identify abnormalities in lung volumes and air flow. b) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will encourage and enable active travel. Wedzicha JA, Miravitlles M, Hurst JR, Calverley PMA, Albert RK, Anzueto A, et al. Eur Respir J 2017; 49:1600791. 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. a) Proportion of journeys made by local residents that are by walking, cycling, public transport or zero- or low-emission vehicles. A full course for NRT is at least 8 weeks, for varenicline it is at least 12 weeks and for bupropion it is at least 8 weeks. Children, young people and adults with chronic respiratory or cardiovascular conditions are given advice at routine health appointments on what to do when outdoor air quality is poor. the NICE guideline on COPD) • previous exacerbation and hospital admission history, and the risk of developing complications • previous sputum culture and susceptibility results • the risk of antimicrobial resistance with repeated courses of antibiotics Give oral antibiotics first line if possible Many exacerbations are not caused by bacterial infections so will not respond to antibiotics. Such services should target minority ethnic and socioeconomically disadvantaged communities in the local population; it is important to ensure that services are easily accessible by people from these groups and that they are encouraged to use them. Or FEV1 below 50% with respiratory failure. siting and designing new buildings, facilities and estates to reduce the need for motorised travel, minimising the exposure of vulnerable groups to air pollution by not siting buildings (such as schools, nurseries and care homes) in areas where pollution levels will be high, siting living accommodation away from roadsides, avoiding the creation of street and building configurations (such as deep street canyons) that encourage pollution to build up where people spend time, including landscape features such as appropriate species of trees and vegetation in open spaces or as 'green' walls or roofs where this does not restrict ventilation. development carried out on a site having an area of 1 hectare or more. 11 June 2019 Bronchoscopic thermal vapour ablation for upper-lobe emphysema (NICE interventional procedures guidance 652) added to. Commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour. Denominator – the number of planning applications for major developments granted permission. Adults over 17 to use an asthma reliever inhaler more often, as needed. Proportion of people who seek support to stop smoking and who agree to take pharmacotherapy who receive a full course. 8 Table 3 highlights the factors … 1.1.5 If no antibiotic is given, give advice about: symptoms (such as sputum colour changes and increases in volume or thickness) worsen rapidly or significantly or, symptoms do not start to improve within an agreed time or. Austin MA, Wills KE, Blizzard L, et al. b) Proportion of people who smoke who receive advice on how to stop. a) Proportion of people who are asked if they smoke by their healthcare practitioner. Numerator – the number of people in the denominator who receive advice on how to stop. Numerator – the number in the denominator who are referred to a pulmonary rehabilitation programme. A guidance on managing exacerbations is expected by Dec 2018. a) Evidence of local processes and guidance that ensure planning applications for major developments include proposals to minimise and mitigate road-traffic-related air pollution. There is evidence that people who smoke are receptive to smoking cessation advice in all healthcare settings. 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. Evidence of local arrangements to ensure that people who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course. Chronic obstructive pulmonary disease (COPD), projected to be the third leading cause of death by 2020, accounts for 6% of deaths globally. 1.2.1 When prescribing an antibiotic for an acute exacerbation of COPD, follow table 1 for adults aged 18 years and over. b) Annual and hourly mean concentrations for nitrogen dioxide (NO, c) Annual and daily mean concentrations for particulate matter of 10 micrometres or less in diameter (PM, d) Annual mean concentration for fine particulate matter of 2.5 micrometres or less in diameter (PM. These are local services providing accessible, evidence based and cost effective support to people who want to stop smoking. Short of breath when hurrying or walking up a slight hill. Denominator – the number of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD. c) Proportion of attendances of people with stable COPD and exercise limitation due to breathlessness that result in the person completing a pulmonary rehabilitation programme. Review of patients in primary care is essential to minimise these risks, and NICE COPD Quality Standard QS10 (2011) recommends that patients hospitalised with an acute exacerbation of COPD are reviewed within 2 weeks of discharge. Numerator – the number in the denominator that were given advice on what to do when outdoor air quality is poor. See the evidence and committee discussion on choice of antibiotic and antibiotic course length. Restrict use of antibiotics for COPD NICE says BMJ 2018 ; 362;k3016 ... Art. Some people with COPD may not be well enough to attend a pulmonary rehabilitation programme within 4 weeks of an acute exacerbation, may not have attended hospital after an acute exacerbation of COPD or may not have been admitted to hospital after their exacerbation of COPD. Denominator – the number of referrals of people with stable COPD and exercise limitation due to breathlessness to pulmonary rehabilitation programmes. b) Overall fuel consumption for public sector vehicle fleets. 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. Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) N.B. DOI: 10.1002/14651858.CD009764.pub3. A diagnosis of COPD is confirmed by post-bronchodilator spirometry. 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