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Health Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults

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Name: Health Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults ASIN/ISBN: 1842575422 Language: English File size: 7.6 Mb

London: National Institute for Clinical Excellence (NICE) 2004 53 1842575422 Clinical Guideline 12 Care guideline This is a publication undertaken by a health technology assessment organisation. For further information please contact the agency using the contact details in Correspondence Address field. This report provides guidelines on the management of chronic obstructive pulmonary disease in adults in primary and secondary care. Treatment Clinical guideline Key priorities for implementation:

The following recommendations have been identified as priorities for implementation.

Diagnose COPD - A diagnosis of COPD should be considered in patients over the age of 35 who have a risk factor (generally smoking) and who present with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze. The presence of airflow obstruction should be confirmed by performing spirometry.

- All health professionals managing patients with COPD should have access to spirometry and be competent in the interpretation of the results.

Stop smoking - Encouraging patients with COPD to stop smoking is one of the most important components of their management. All COPD patients still smoking, regardless of age, should be encouraged to stop, and offered help to do so, at every opportunity.

Effective inhaled therapy - Long-acting inhaled bronchodilators (beta2-agonists and/or anticholinergics) should be used to control symptoms and improve exercise capacity in patients who continue to experience problems despite the use of short-acting drugs.

- Inhaled corticosteroids should be added to long-acting bronchodilators to decrease exacerbation frequency in patients with an FEV1 less than or equal to 50% predicted who have had two or more exacerbations requiring treatment with antibiotics or oral corticosteroids in a 12-month period.

Pulmonary rehabilitation for all who need it - Pulmonary rehabilitation should be made available to all appropriate patients with COPD.

Use non-invasive ventilation - Non-invasive ventilation (NIV) should be used as the treatment of choice for persistent hypercapnic ventilatory failure during exacerbations not responding to medical therapy. It should be delivered by staff trained in its application, experienced in its use and aware of its limitations.

- When patients are started on NIV, there should be a clear plan covering what to do in the event of deterioration and ceilings of therapy should be agreed.

Manage exacerbations - The frequency of exacerbations should be reduced by appropriate use of inhaled corticosteroids and bronchodilators, and vaccinations.

The impact of exacerbations should be minimised by: - giving self-management advice on responding promptly to the symptoms of an exacerbation - starting appropriate treatment with oral corticosteroids and/or antibiotics - use of non-invasive ventilation when indicated - use of hospital-at-home or assisted-discharge schemes.

Multidisciplinary working - COPD care should be delivered by a multidisciplinary team. Subject indexing by CRD Pulmonary-Disease,-Chronic-Obstructive; Lung-Diseases; Primary-Health-Care; Hospitals; Practice-Guidelines English MidCity Place, 71 High Holborn, London WC1V 6NA, UK Tel: +44 020 7067 5800 Fax: +44 020 7067 5801

_http://www.nice.org.uk/cat.asp?c=104441 32004000139 3 March 2004 Buy Book at Lowest Price on Amazon

Free register and download UseNet downloader, then you can FREE Download from UseNet.     Download without Limit " Health Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults " from UseNet for FREE! Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care- clinical guideline 12 2004 By Publisher: National Institute for Clinical Excellence Number Of Pages: 54 Publication Date: 2004 Health Technology Assessment (HTA) Database - Full record display Chronic obstructive pulmonary disease: management of chronic obstructive pulmonary disease in adults in primary and secondary care National Institute for Clinical Excellence	Publisher	Year published	Pages	ISBN	Series	Publication type	Record status	Authors' objectives	Type of intervention	Study design	Authors' conclusions	Subject index terms status	Subject index terms	Language	Address for correspondence	Web address of publication/organisation	Accession number	Database entry date

 

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