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National Clinical Guideline Centre (UK). Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care [Internet]. London: Royal College of Physicians (UK); 2010 Jun. (NICE Clinical Guidelines, No. 101.)

Cover of Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease: Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care [Internet].

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Preface to original guideline

COPD is common but for many years it was largely ignored on the (false) grounds that little could be done. However in the last 10 years there has been a surge in research interest and several new treatment options. The first Guidelines on the Management of COPD (published by the British Thoracic Society in Jan 1997) led to significant improvements in the recognition and care of COPD. Since then new treatment possibilities including long-acting bronchodilator drugs, respiratory rehabilitation services, and non-invasive ventilation in respiratory failure, have meant that a revision is overdue.

The guideline was commissioned from NICE and the scope for the project was developed by National Collaborating Centre with input from all the stakeholders registered with NICE. The agreed final project scope advises that since it is aimed at the NHS, the guideline should concentrate on the health aspects of COPD. However it should also include the need for support from other agencies including social services, and should set out the interface with such services but not discuss their detailed provision.

There are other national and international guidelines for COPD but this is the first to systematically bring together and examine all the evidence in the published literature. The systematic nature of the approach provides an explicit audit trail of what has and has not been identified and how it was treated. Because the project scope was so wide ranging, even with an extremely hard working and dedicated team, it has not been possible to examine every paper on every question. Pragmatic choices have had to be made. Thus we searched first for the best quality research studies and if several were found that provided a strong evidence base, we did not continue to search for papers of lesser quality. The searching for, and systematic critical appraisal of, studies has been done using standard techniques and all searches will be available to future researchers. We believe it is unlikely that important papers have been missed either by the technical team in their searches or by the expertise of the guideline groups.

The guideline had to cover all aspects of the disease so that local care pathways could be defined using the document. Where there were gaps between the evidence, these have been filled with best practice recommendations based on a formal consensus of the experts on our guideline groups.

In each section of the document the level of supporting evidence is made clear on the understanding that the stronger the evidence the greater likelihood that the recommendations based on it are sound. However the reader should not equate level of evidence with strength of recommendation - some of the most important recommendations with greatest consequences for the health service or for people with COPD have been made by group consensus because there was inadequate evidence. This is what the experts believe to be best practice i.e. what they would recommend for their patients or relatives.

While the detail of local implementation of this guideline may vary (according to local facilities and geography), the main aims ought to be common across England and Wales and if adopted should lead to better standards of care and thus better outcomes from this often distressing condition. But implementation will depend on both clinicians and managers working together to ensure that resources and patient needs are matched. COPD is a common disease with many different facets to management that varies with the stages of disease and with individual patient circumstance. The evidence of the last 6 years since the first British guideline is that it is possible to work together and to improve care.

There are some recommendations that either may seem to challenge the international COPD guidelines or may rankle with individual clinicians. Our guideline group believe their recommendations to be the best advice for patient care – and hope that any who disagree will feel challenged to produce and publish evidence to either confirm or refute what this guideline sets out.

It is therefore a pleasure to welcome you to this Guideline on the management of COPD. We hope that all those involved in health care (those that commission care, those that deliver care, and the patient and carer groups) ensure that these guidelines are used and to that end we commend the audit/implementation criteria set out in the final section as ways of measuring the implementation process. Those with COPD deserve no less.

Dr Mike Pearson

Director, National Collaborating Centre - Chronic Conditions

Copyright © 2010, National Clinical Guideline Centre - Acute and Chronic Conditions.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use. The rights of National Clinical Guideline Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

Bookshelf ID: NBK65044


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