According to the National Institute for Health and Care Excellence (NICE), patients suffering from stable chronic obstructive pulmonary disease (COPD) and an inability to efficiently exercise due to breathlessness should be referred to a pulmonary rehabilitation program.
NICE recently updated their quality standards and recommended that patients admitted in hospitals for an acute exacerbation of COPD must enlist in a pulmonary rehabilitation program within four weeks of being discharged. They stated that this reduces the short-term risk of going back to the hospital and also improves quality of life and the ability to exercise moderately.
Updated NICE Quality Standards For Managing COPD
The updated NICE quality standards, previously known as the chronic obstructive pulmonary disease quality standard describe vital areas for improving the quality of a defined service or care area. Each standard focuses on a prioritized set of comprehensive, specific and concise measurable statements. It covers only the assessment, diagnosis and management of COPD, and does not deal with its prevention, screening, or identification of potential cases.
The update, which took place in February 2016, added various new recommendations for managing COPD, such as:
- A new statement on the availability of emergency oxygen during an exacerbation
- Supporting and motivating individuals to stop smoking, which is one of the most significant efforts in managing COPD
- Essential requirement for referring smokers and ex-smokers to an evidence-based smoking cessation service
- Collaborating with the high-quality requirements for adult individuals nearing the end of life
Efforts To Manage COPD
About three million people in the UK suffer from COPD, of which two million remain undiagnosed. Smokers and ex-smokers are at an increased risk of developing COPD, as well as those exposed to harmful chemicals, fumes or dust. Its prevalence increases as one grows older, and is significantly linked with levels of deprivation.
According to the updated quality standards of NICE, all individuals suffering from COPD must enroll in a pulmonary rehabilitation program. The latter cares for people with chronic respiratory impairment and improves their ability to exercise, provides information and relevant diet advice tailored to the individual needs of the patient. They stated that such programs must last for at least six weeks and should include two sessions per week under the supervision of an expert.
The standards also stated that patients above 35 years of age, with an increased risk factor and presenting symptom(s), must have a firm diagnosis via ‘post-bronchodilator spirometry’ as a part of primary healthcare.
Mike McKevitt, head of patient services at The British Lung Foundation commented on the issued statements, “Pulmonary rehabilitation is a cost effective method for improving patient health and quality of life. We hope that these standards will encourage patient access and compliance with pulmonary rehabilitation across the UK”.
Quality Standards for Managing COPD: Other Recommendations
Other recommendations related to COPD include
- Assessing patients’ inhaler technique before starting treatment and then regularly as the treatment progresses.
- Measuring arterial blood gases of patients with stable COPD and a persistent resting stable oxygen saturation level of 92% or lower to determine whether they require long-term oxygen therapy
- Maintaining the oxygen saturation levels at 88-92% for patients who might require emergency oxygen due to a sudden flare-up of symptoms
COPD isn’t curable, but it is manageable. Early diagnosis and treatment can significantly lower the decline in optimum lung function and enhance quality of life. Presently, pharmacological and other therapies are being used to manage symptoms and avoid disability, but these interventions have a limited or no impact on airflow obstruction. The statements issued in the revised NICE quality standards describe a more comprehensive and long-term solution to deal with COPD and its associated complications. If followed precisely, the standards can notably improve patients’ quality of life and performance.