nice guidelines copd exacerbation

c) Evidence of local arrangements to ensure that primary care services providing post-bronchodilator spirometry are supported by quality control processes. [, An oxygen saturation (measured with a pulse oximeter) that is persistently 92% or less when the person is in a chronic stable state and is at rest (is not, and has not recently, been exercising). NICE Bites No 115, February 2019, includes one topic: chronic obstructive pulmonary disease (COPD). b) Evidence that public sector organisations require commissioned transport or fleet services to reduce emissions from their vehicle fleets to address air pollution. Everything NICE has said on diagnosing and managing chronic obstructive pulmonary disease in people aged 16 and over in an interactive flowchart. 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. People who smoke who have set a quit date with an evidence-based smoking cessation service are assessed for carbon monoxide levels 4 weeks after the quit date. Reducing emissions from public sector vehicle fleets will help to reduce road-traffic-related air pollution. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. Numerator – the number in the denominator who have their arterial blood gases measured to assess whether they need LTOT. 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. Assessing proposals to minimise and mitigate road-traffic-related air pollution will help to ensure they are robust and evidence based. People with chronic obstructive pulmonary disease (COPD) who are prescribed an inhaler have their inhaler technique assessed when starting treatment and then regularly during treatment. are at least 6 weeks in duration and include a minimum of twice-weekly supervised sessions, include supervised, individually tailored and prescribed, progressive exercise training including both aerobic and resistance training. For guidance on assessing the need for hospital referral, see NICE guideline: Chronic obstructive pulmonary disease in over 16s (see Useful resources). In some people, uncontrolled oxygen therapy may reduce the depth and frequency of breathing, leading to a rise in blood carbon dioxide levels and a fall in the blood pH (acidosis). [Adapted from. This classification has been widely used to determine the severity of exacerbation in research studies, with more symptoms indicating a more severe exacerbation. a) Proportion of journeys made by local residents that are by walking, cycling, public transport or zero- or low-emission vehicles. 1.1.7 Refer people with an acute exacerbation of COPD to hospital if they have any symptoms or signs suggesting a more serious illness or condition (for example, cardiorespiratory failure or sepsis) and in line with the NICE guideline on COPD in over 16s. If necessary, actions to mitigate the impact of charges on specific groups should be identified. 05 December 2018, an acute exacerbation of chronic obstructive pulmonary disease (COPD) is a sustained worsening of symptoms from a person's stable state, a range of factors (including viral infections and smoking) can trigger an exacerbation, many exacerbations (including some severe exacerbations) are not caused by bacterial infections so will not respond to antibiotics. previous antibiotic use, which may have led to resistant bacteria.Send a sputum sample for culture and susceptibility testing if symptoms have not improved following antibiotic treatment and this has not been done already. Increased cough. This guideline includes recommendations on: treatment; reassessment; referral and seeking specialist advice; choice of antibiotic; Who is it for? COPD Exacerbations: An Official ERS/ATS Clinical Practice Guideline. Stoller JK. An exacerbation of COPD causes an acute deterioration of respiratory symptoms, particularly increased breathlessness and cough, and increased sputum volume and/or a change in the colour of the sputum. Development involving any one or more of the following: Local planning authorities should ensure that proposals to encourage active travel in planning applications for major developments are accessible to people with limited mobility or disabilities. Controlled oxygen therapy must therefore be administered by a delivery device and at a flow rate that helps the oxygen saturation to be maintained between 88% and 92%. Acute exacerbations of chronic obstructive pulmonary disease. A summary of prescribing recommendations from NICE guidance NICE Bites February 2019: No. [. “The latest NICE guidance on COPD has managed to maintain a simplicity that makes sense to most clinicians. Denominator – the number of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD. Co-existent hypoxaemia is usually mild and easily corrected. 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 Inhaled short-acting beta-agonists are the cornerstone of drug therapy for acute exacerbations. Elderly people, or people with learning disabilities, physical disabilities or cognitive impairment may experience difficulties learning and retaining the adequate inhaler technique to ensure that they get the optimal treatment dose. 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. include a defined, structured education programme. Denominator – the number of people identified as smokers in any healthcare setting. b) Proportion of referrals of people with stable COPD and exercise limitation due to breathlessness that result in the person attending a pulmonary rehabilitation programme. There should be a discussion about risks and benefits of using NRT with young people aged 12–17 and pregnant or breastfeeding women. See the evidence and committee discussion on antibiotics. a) Proportion of people who are asked if they smoke by their healthcare practitioner. This can vary by healthcare setting. People who seek support to stop smoking and who agree to take pharmacotherapy are offered a full course. b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary, community and secondary care services are trained and competent in teaching inhaler technique. Numerator – the number in the denominator who start a pulmonary rehabilitation programme within 4 weeks of discharge. Or FEV1 below 50% with respiratory failure. development carried out on a site having an area of 1 hectare or more. The presence all 3 symptoms was defined as type 1 exacerbation; 2 of the 3 symptoms was defined as type 2 exacerbation; and 1 of the 3 symptoms with the presence of 1 or more supporting symptoms and signs was defined as type 3 exacerbation. BMJ 2010; 341:c5462. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian. NICE guidance recommends that young people aged 12–17 who smoke should be offered information, advice and support on how to stop smoking and be encouraged to use local evidence-based smoking cessation services. People who smoke are more likely to stop smoking if they are offered a combination of interventions, with combined behavioural support and pharmacotherapy the most likely to be successful. 1. Numerator – the number of people in the denominator who are referred to an evidence-based smoking cessation service. Periods of poor air quality are associated with adverse health effects, including asthma attacks, reduced lung function, and increased mortality and admissions to hospital. Upper airway symptoms (eg, colds and sore throats). People with COPD and a persistent resting stable oxygen saturation of 92% or less should be assessed for their suitability for LTOT, which can improve survival, pulmonary haemodynamics, polycythaemia and neuropsychological health. b) Evidence of local arrangements and written clinical protocols to ensure that healthcare professionals in primary care using post-bronchodilator spirometry are trained and competent in its use. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. For guidance on antibacterial treatment in acute exacerbations of COPD, see Chronic obstructive pulmonary disease, acute exacerbations in Respiratory system infections, antibacterial therapy . Denominator – the number of people with an acute exacerbation of COPD and persistent acidotic hypercapnic ventilatory failure that is not improving after 1 hour of optimal medical therapy. To identify organisms if sputum is persistently present and purulent, To exclude asthma if diagnostic doubt remains. Numerator – the number of people in the denominator who are assessed for carbon monoxide levels 4 weeks after the quit date. Denominator – the number of people who report that they smoke during face-to-face contact with a healthcare practitioner. Increased cough; increased sputum purulence and increased sputum volume. Numerator – the number of people in the denominator who are asked if they smoke by their healthcare practitioner. All tiers of local government including county, district and unitary authorities, as well as regional bodies and transport authorities. Smoking cessation services provide the most effective route to stopping smoking, but many people who smoke do not use these services when they try to stop. Advice should be culturally appropriate and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. LTOT is used to treat people with stable COPD who have developed daytime hypoxaemia. 27 February 2019 Air pollution: outdoor air quality and health (NICE quality standard 181) added. Management of COPD exacerbations: an ERS/ATS guideline. Starting a pulmonary rehabilitation programme within 4 weeks of hospital discharge after an acute exacerbation reduces the short-term risk of hospital readmission, and improves the quality of life and the short-term exercise capacity of people with COPD. Hospital discharge care bundles are designed to ensure that every person leaving hospital receives the best care. Proportion of people aged over 35 years presenting with a risk factor and one or more symptoms of COPD who have post-bronchodilator spirometry. (a sustained worsening of the person's symptoms from their usual stable state which is beyond normal day-to-day variations, and is acute in onset: commonly reported symptoms are worsening breathlessness, cough, increased sputum production and change in sputum colour), (this includes any previous, secure diagnosis of asthma or of atopy, a higher blood eosinophil count, substantial variation in, body mass index, airflow obstruction, dyspnoea and exercise capacity, Comité Européen de Normalisation (European Committee for Standardisation), (in the context of this guidance, the term 'cor pulmonale' has been adopted to define a clinical condition that is identified and managed on the basis of clinical features; this clinical syndrome of cor pulmonale includes patients who have right heart failure secondary to lung disease and those in whom the primary pathology is retention of salt and water, leading to the development of peripheral oedema), global initiative for chronic obstructive lung disease, (people who are not taking long-term oxygen therapy and who have a mean PaO, Medicines and Healthcare Products Regulatory Agency, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, (here, the term theophylline refers to slow-release formulations of the drug), Acute coronary syndromes: early management, Anaphylaxis: assessment and referral after emergency treatment, Anaemia management in people with chronic kidney disease, Hyperphosphataemia in chronic kidney disease, Sickle cell disease: acute painful episode, Genomic biomarker-based treatment for solid tumours, Metastatic malignant disease of unknown primary origin, Suspected cancer recognition and referral, Acute coronary syndromes: secondary prevention and rehabilitation, Cardiovascular disease: identifying and supporting people most at risk of dying early, Prophylaxis against infective endocarditis, Chronic fatigue syndrome myalgic encephalomyelitis, Diabetes and other endocrine, nutritional and metabolic conditions, Endocrine, nutritional and metabolic conditions, Lifestyle weight management services for overweight or obese adults, Lifestyle weight management services for overweight or obese children and young people, Dyspepsia and gastro-oesophageal reflux disease, Surgical management of otitis media with effusion in children, Preventing sexually transmitted infections and under-18 conceptions, Intrapartum care for women with existing medical conditions, Intrapartum care for women with obstetric complications, Developmental follow-up of children and young people born preterm, Specialist neonatal respiratory care in preterm babies, Antenatal care for uncomplicated pregnancies, Pregnancy and complex social factors: service provision, Urinary incontinence and pelvic organ prolapse in women, Antimicrobial prescribing for common infections, Bites and stings – antimicrobial prescribing, Bronchiectasis (non-cystic fibrosis) – antimicrobial prescribing, Cellulitis and erysipelas – antimicrobial prescribing, Self-limiting respiratory tract and ear infections – antibiotic prescribing, Bacterial meningitis and meningococcal septicaemia in under 16s, Prevention and control of healthcare-associated infections, Antisocial behaviour and conduct disorders in children and young people, Obsessive-compulsive disorder and body dysmorphic disorder, Attachment difficulties in children and young people, Common mental health disorders in primary care, Dementia, disability and frailty in later life: mid-life approaches to delay or prevent onset, Harmful sexual behaviour among children and young people, Health of people in the criminal justice system, Learning disabilities and behaviour that challenges, Mental health problems in people with learning disabilities, Coexisting severe mental illness and substance misuse: assessment and management in healthcare settings, Rehabilitation for adults with complex psychosis, Service user experience in adult mental health services, Transition between community or care home and inpatient mental health settings, Social care for older people with multiple long-term conditions, Urinary incontinence in neurological disease, Oral health improvement for local authorities and their partners, Community pharmacies: promoting health and wellbeing, Vitamin D: supplement use in specific population groups, Mental wellbeing and independence in older people, Social and emotional wellbeing for children and young people, Smokeless tobacco cessation: South Asian communities, Smoking: tobacco harm-reduction approaches, End of life care for people with life-limiting conditions, Looked-after babies, children and young people, Transition from children's to adults' services, Care and support of people growing older with learning disabilities, Excess winter deaths and illnesses associated with cold homes, Coexisting severe mental illness and substance misuse: community health and social care services, People’s experience in adult social care services, Service delivery, organisation and staffing, Emergency and acute medical care in over 16s: service delivery and organisation, Safe staffing for nursing in adult inpatient wards in acute hospitals, Managing medicines for people receiving social care in the community, Transition between inpatient hospital settings and community or care home settings for adults with social care needs, Opioids for pain relief in palliative care, Safe midwifery staffing for maternity settings, Controlled drugs: safe use and management, Managing long-term sickness absence and capability to work, Workplace health: policy and management practices, Chronic obstructive pulmonary disease – everything NICE says in an interactive flowchart, Chronic obstructive pulmonary disease overview, Antibiotics for treating exacerbations of COPD, Exacerbations of COPD: treatments only delivered in hospital, Pulmonary rehabilitation for stable COPD and exercise limitation, Pulmonary rehabilitation after an acute exacerbation, Hospital discharge care bundle (placeholder), Reducing emissions from public sector vehicle fleets, Advice for people with chronic respiratory or cardiovascular conditions, Accident prevention (see unintentional injuries among under-15s), Acute hospitals (adult inpatient wards), safe staffing for nursing, Acute myocardial infarction (see acute coronary syndromes: early management), ADHD (see attention deficit hyperactivity disorder), Adult carers (see supporting adult carers), Adverse drug reactions (see drug allergy), Allergy, food (see food allergy in children and young people), Allergy, severe reaction (see anaphylaxis), Amyotrophic lateral sclerosis (see motor neurone disease), Ankylosing spondylitis (see spondyloarthritis), Antibiotic prescribing for diabetic foot infections (see foot care for people with diabetes), Antibiotics for early-onset neonatal infection (see early-onset neonatal infection), Antibiotics in respiratory tract and ear infections, Antimicrobials for bronchiectasis (non-cystic fibrosis), Antimicrobials for cellulitis and erysipelas, Antisocial personality disorder (see personality disorders), Anxiety (see generalised anxiety disorder), Axial spondyloarthritis (see spondyloarthritis), Behaviour that challenges and learning disabilities, Benign prostatic hyperplasia (see lower urinary tract symptoms in men), Blackouts (see transient loss of consciousness), Bladder infection (see urinary tract infections), Body dysmorphic disorder (see obsessive-compulsive disorder), Borderline personality disorder (see personality disorders), Bowel cancer prevention (see colonoscopic surveillance), Bowel incontinence (see faecal incontinence), Brain cancer (see brain tumours and metastases), Breast cancer, early and locally advanced, Breastfeeding (see maternal and child nutrition), Cancer of unknown primary origin (see metastatic malignant disease of unknown primary origin), Catheter-associated UTIs (see urinary tract infections), Challenging behaviour and learning disabilities, Child maltreatment (see child abuse and neglect), Childbirth (see fertility, pregnancy and childbirth), Children's attachment (see attachment difficulties in children and young people), Children's palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Cholelithiasis, cholecystitis and choledocholithiasis (see gallstone disease), Chronic kidney disease, anaemia management, Chronic kidney disease, hyperphosphataemia, Cold homes, reducing preventable excess winter deaths (see excess winter deaths and illnesses associated with cold homes), Colorectal cancer prevention (see colonoscopic surveillance), Community-acquired pneumonia (see pneumonia), Complex psychosis, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Complex social factors and pregnancy: service provision, Conduct disorders and antisocial behaviour in children and young people, Cough (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Criminal justice system, health of people in, Deep vein thrombosis (see venous thromboembolism), Dental perioperative care (see perioperative care), Dental services, local authority improvement approaches (see oral health improvement for local authorities and their partners), Diverticulitis (see diverticular disease), Diverticulosis (see diverticular disease), Dual diagnosis (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Dual diagnosis (see coexisting severe mental illness and substance misuse: community health and social care services), End of life care for infants, children and young people (see end of life care for people with life-limiting conditions), Endocarditis prophylaxis (see prophylaxis against infective endocarditis), Enteral nutrition (see nutrition support in adults), Falls in older people (see preventing falls in older people), Fibroids, uterine (see heavy menstrual bleeding), Fractured neck of femur (see hip fracture), Gastric cancer (see oesophageal and gastric cancer), Gastroenteritis in children (see diarrhoea and vomiting in children), Gastro-oesophageal reflux disease and dyspepsia, Glue ear (see surgical management of otitis media with effusion in children), Gynaecological conditions (see urogenital conditions), Haematemesis (see acute upper gastrointestinal bleeding), Haematological cancers (see blood and bone marrow cancers), Healthcare-associated infections, prevention and control, Heartburn (see dyspepsia and gastro-oesophageal reflux disease), Histology-independent treatment for solid tumours, Hospital-acquired pneumonia (see pneumonia), Hypercholesterolaemia, familial (see familial hypercholesterolaemia), Hypercholesterolaemia, non-familial (see cardiovascular disease prevention), Hyperkinetic disorder (see attention deficit hyperactivity disorder), Incontinence, urinary in neurological disease, Independence and mental wellbeing in older people, Indoor air quality at home (see air pollution), Infant feeding (see maternal and child nutrition), Inflammatory bowel disease (see Crohn's disease), Inflammatory bowel disease (see ulcerative colitis), Interstitial lung disease (see idiopathic pulmonary fibrosis), Intraoperative care (see perioperative care), Labour, care for women with existing medical conditions (see intrapartum care for women with existing medical conditions), Labour, care for women with obstetric complications (see intrapartum care for women with obstetric complications), Larynx, mouth and throat cancer (see upper aerodigestive tract cancer), Learning disabilities, mental health problems, Leukaemia (see blood and bone marrow cancers), Life-limiting conditions, end of life care (see end of life care for people with life-limiting conditions), Lipid modification (see cardiovascular disease prevention), Long-term sickness absence and capability to work, Lymphoma (see blood and bone marrow cancers), Maternity settings, safe midwifery staffing, Medicines adherence (see medicines optimisation), Meningitis, bacterial and meningococcal septicaemia, Menorrhagia (see heavy menstrual bleeding), Mental health disorders (common) in primary care, Mental health services, adult service user experience, Mental illness (severe) and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Metabolic conditions (see endocrine, nutritional and metabolic conditions), Monitoring ill patients (see acutely ill patients in hospital), Mouth, larynx and throat cancer (see upper aerodigestive tract cancer), Multiple long-term conditions (see multimorbidity), Multiple pregnancy (see twin and triplet pregnancy), Myalgic encephalomyelitis, chronic fatigue syndrome, Myocardial infarction, secondary prevention and rehabilitation (see acute coronary syndromes: secondary prevention and rehabilitation), Neonatal infection (see early-onset neonatal infection), Neurological disease, urinary incontinence, Nocturnal enuresis (see bedwetting in children and young people), Non-STEMI (see acute coronary syndromes: early management), Nose conditions (see ear, nose and throat conditions), Nutritional conditions (see endocrine, nutritional and metabolic conditions), Older people with social care needs and multiple long-term conditions (see social care for older people with multiple long-term conditions), Older people: independence and mental wellbeing, Otitis media (acute) (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Otitis media with effusion, surgical management in children, Outdoor air quality and health (see air pollution), Overactive bladder (see urinary incontinence), Overweight or obese adults, lifestyle weight management services, Overweight or obese children and young people, lifestyle weight management services, Palliative care, for people with life-limiting conditions (see end of life care for people with life-limiting conditions), Parenteral nutrition (see nutrition support in adults), People with learning disabilities, mental health problems, Postoperative care (see perioperative care), Pre-eclampsia (see hypertension in pregnancy), Pregnancy (see fertility, pregnancy and childbirth), Pregnancy, preventing teenage (see preventing sexually transmitted infections and under-18 conceptions), Pregnancy, twins and triplets (see twin and triplet pregnancy), Premature labour and birth (see preterm labour and birth), Premature ovarian insufficiency (see menopause), Preoperative care (see perioperative care), Psoriatic arthritis (see spondyloarthritis), Psychosis with coexisting substance misuse (see coexisting severe mental illness and substance misuse: assessment and management in healthcare settings), Psychosis, complex, rehabilitation for adults (see rehabilitation for adults with complex psychosis), Pulmonary embolism (see venous thromboembolism), Pyelonephritis (see urinary tract infections), Reactive arthritis (see spondyloarthritis), Renal failure, acute (see acute kidney injury), Renal failure, established (see chronic kidney disease), Renal replacement therapy (see chronic kidney disease), Respiratory syncytial virus infection (see bronchiolitis in children), Respiratory tract and ear infections (self-limiting), antibiotic prescribing, Septicaemia, meningococcal and bacterial meningitis (see bacterial meningitis and meningococcal septicaemia), Severe mental illness and substance misuse, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Sexually transmitted infections, prevention, Shoulder replacement (see joint replacement), Sinusitis (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Skin cancer prevention (see sunlight exposure: risks and benefits), Social care services, people's experience, Social factors (complex) in pregnancy: service provision, Sore throat (see self-limiting respiratory tract and ear infections – antibiotic prescribing), Spinal cord compression, metastatic (see metastatic spinal cord compression), STEMI (see acute coronary syndromes: early management), Stomach cancer (see oesophageal and gastric cancer), Substance misuse and severe mental illness, coexisting (see coexisting severe mental illness and substance misuse: community health and social care services), Surgical site infection (see prevention and control of healthcare-associated infections), Suspected neurological conditions recognition and referral (see neurological conditions), Teenage pregnancy prevention (see preventing sexually transmitted infections and under-18 conceptions), Termination of pregnancy (see abortion care), Throat conditions (see ear, nose and throat conditions), Throat, larynx and mouth cancer (see upper aerodigestive tract cancer), Tobacco cessation (smokeless): South Asian communities, Type 1 and type 2 diabetes in children and young people, Unstable angina (see acute coronary syndromes: early management), Urological conditions (see urogenital conditions), Vaccinations (see immunisation for children and young people), Weight management services (lifestyle) for overweight or obese adults, Weight management services (lifestyle) for overweight or obese children and young people, Winter deaths and illnesses associated with cold homes (see excess winter deaths and illnesses associated with cold homes), Young offender institutions, health of people in, Chronic obstructive pulmonary disease in adults, Air pollution: outdoor air quality and health, assess and reduce the environmental impact of implementing NICE recommendations, Chronic obstructive pulmonary disease in over 16s: diagnosis and management, Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing, Roflumilast for treating chronic obstructive pulmonary disease, Electrical stimulation to improve muscle strength in chronic respiratory conditions, chronic heart failure and chronic kidney disease, Bronchoscopic thermal vapour ablation for upper-lobe emphysema, Endobronchial valve insertion to reduce lung volume in emphysema, Insertion of endobronchial nitinol coils to improve lung function in emphysema, Living-donor lung transplantation for end-stage lung disease, Lung volume reduction surgery for advanced emphysema, Procalcitonin testing for diagnosing and monitoring sepsis (ADVIA Centaur BRAHMS PCT assay, BRAHMS PCT Sensitive Kryptor assay, Elecsys BRAHMS PCT assay, LIAISON BRAHMS PCT assay and VIDAS BRAHMS PCT assay), Chronic obstructive pulmonary disease: fluticasone furoate, umeclidinium and vilanterol (Trelegy), Chronic obstructive pulmonary disease: beclometasone, formoterol and glycopyrronium (Trimbow), Chronic obstructive pulmonary disease: tiotropium/olodaterol (Spiolto Respimat), Chronic obstructive pulmonary disease: aclidinium/formoterol, Chronic obstructive pulmonary disease: olodaterol, Chronic obstructive pulmonary disease: umeclidinium inhaler (Incruse), Chronic obstructive pulmonary disease: umeclidinium/vilanterol combination inhaler (Anoro Ellipta), Chronic obstructive pulmonary disease: beclometasone/formoterol (Fostair), Chronic obstructive pulmonary disease: indacaterol/glycopyrronium (Ultibro Breezhaler), Chronic obstructive pulmonary disease: fluticasone furoate plus vilanterol, Chronic obstructive pulmonary disease: glycopyrronium bromide, Chronic obstructive pulmonary disease: aclidinium bromide, myCOPD for self-management of chronic obstructive pulmonary disease, PulmoVista 500 for monitoring ventilation in critical care, Video laryngoscopes to help intubation in people with difficult airways, myAIRVO2 for the treatment of chronic obstructive pulmonary disease, VIDAvision for lung volume analysis in emphysema, Nasal Alar SpO2 sensor for monitoring oxygen saturation by pulse oximetry, Needle-free arterial non-injectable connector, chronic obstructive pulmonary disease in adults quality standard, smoking: supporting people to stop quality standard, air pollution: outdoor air quality and health quality standard, Royal College of Physicians’ National COPD Audit Programme, Chronic obstructive pulmonary disease in over 16s: diagnosis and management. 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