Guidelines for chronic obstructive pulmonary disease

Faced with a plethora of guidelines, doctors in primary and secondary care may well ask, why another guideline and particularly a guideline for chronic obstructive pulmonary disease and how is it going to affect practice?

Guidelines from the Global Initiative in Obstructive Lung Disease were updated in 2003.1 The National Institute for Clinical Excellence (NICE) published a guideline earlier this year.2 New guidelines from the European Respiratory Society and American Thoracic Society appeared recently (www.thoracic.org/copd). The existence of so many guidelines reflects the increasing recognition of the burden of chronic obstructive pulmonary disease both on patients and on healthcare resources. Whereas the condition was considered to have few therapeutic options previously, it is now considered treatable, and over the past five years increasing evidence supports pharmacological and non-pharmacological treatments. This article discusses the guideline published for NICE by the National Collaborating Centre for Chronic Conditions and many members of the British Thoracic Society and makes some comparisons with other guidelines. The 1997 British Thoracic Society guidelines needed updating,3 which is what the NICE guideline does. It is truly evidence based, wide ranging, and deals with diagnosis, assessment of severity, and treatment of chronic obstructive pulmonary disease.

The evidence on which the recommendations in the NICE guideline are based is presented in a standard format for each section, indicating which studies were reviewed, with evidence based statements from these studies followed by consensus statements from the guidelines development …