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December 2024: Update to Chronic Obstructive Pulmonary Disease (COPD) guidance
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December 2024: Update to Chronic Obstructive Pulmonary Disease (COPD) guidance
Management of Chronic Obstructive Pulmonary Disease (COPD): updated guidance based on the GOLD 2024 report with additional information from NICE Guideline NG115 (2019). Non inhaled prevention and maintenance strategies (smoking cessation, vaccinations, self-management plans, pulmonary rehabilitation [where available]) remain essential in the management of COPD. Rescue short-acting bronchodilators should continue to be prescribed to all patients for immediate symptom relief.
Key updates to the formulary guidance include:
- Eosinophil count to be taken into account when considering the use of ICS (this recommendation features more prominently than in previous guidance).
- Updated recommendations for initial pharmacological treatment:
- LAMA monotherapy is recommended for all patients in group A (if unsuitable, LABA may be considered)
- LABA + LAMA combination therapy is recommended for all patients in group B
- Groups C and D have been combined into new group E, which includes all patients with ≥ 2 moderate exacerbations or ≥ 1 exacerbation leading to hospitalisation in the last year, regardless of symptom score
- These patients are now recommended LABA + LAMA combination therapy as initial treatment, with triple therapy (ICS + LABA + LAMA) considered for those with blood eosinophils ≥ 0.3x109/L
- ICS + LABA is not encouraged (GOLD suggests triple therapy with ICS + LABA + LAMA is superior).
- Updated recommendations for follow up pharmacological treatment. Consider the predominant treatable trait to target: dyspnoea or exacerbations. Use exacerbation pathway if both exacerbations and dyspnoea need to be targeted.
- A visual summary which incorporates local treatment choices is in development.
- GOLD no longer refers to asthma and COPD overlap, instead emphasizing that these are different disorders, which may co-exist in an individual patient. If a concurrent diagnosis of asthma is suspected, pharmacotherapy should primarily follow asthma guidelines. The formulary information on Asthma - COPD Overlap Syndrome (ACOS) has been withdrawn.
See here for the formulary guidance.
