NICE guidelines for chronic obstructive pulmonary disease: implications for primary care

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the UK with around 30 000 deaths per annum. There are an estimated 3 million people with the disease (900 000 diagnosed and 2.1 million undiagnosed), and COPD is estimated to be the third highest cause of mortality worldwide by the year 2020.1 The National Institute for Health and Clinical Excellence (NICE) 2010 guidelines for the management of COPD in primary and secondary care1 are a partial update of the original guidelines published in 2004.2 The new recommendations are principally concerned with spirometry, assessment of disease severity, and management of stable disease. A diagnosis of COPD is dependent on the presence of characteristic symptoms of cough and breathlessness, examination (principally to rule out other causes of cough/breathlessnes, such as cardiac disease, other lung disease), and the demonstration of airflow obstruction on spirometry. The 2004 guidelines were unclear whether pre- or post-bronchodilator readings of forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) should be used to diagnose COPD. The new guidelines recommend that postbronchodilator readings should be used, which corresponds with requirements of the current UK Quality and Outcomes Framework.3 There has been debate surrounding the merits of using a fixed cut-off point of 0.7 of FEV1/FVC ratio for diagnosing COPD or using the lower limit of normal (LLN) where the …