Chronic Obstructive Pulmonary Disease (COPD) Pathway

The Chronic Obstructive Pulmonary Disease (COPD) Pathway defines the core components of an optimal service for people with COPD.

The NHS RightCare Pathway for COPD provides a national case for change and a set of resources to support local health economies to concentrate their improvement efforts where there is greatest opportunity to address variation and improve population health.

Benralizumab for Chronic Obstructive Pulmonary Disease (COPD)

Benralizumab is a new drug being developed for the treatment of chronic obstructive pulmonary disease. It is administered by injection under the skin and acts by targeting specific proteins that
causes the airway to narrow. If benralizumab is licensed for use in the UK, it could be a new treatment option for patients with chronic obstructive pulmonary disease that may improve quality of life and reduce the number of exacerbations.

From the NIHR Innovation Observatory

COPD Best Practice Guide

This best practice guideline and series of case studies from NHS Scotland bring a strong focus to streamlining COPD management, using the Six Essential Actions of Unscheduled Care, and in particular essential actions 5 and 6

NIHR Signal Use of a facemask ventilator can reduce deaths in severe flare-ups of COPD

People admitted to hospital with a severe exacerbation of chronic obstructive pulmonary disease (COPD) were 46% less likely to die if they received non-invasive ventilation. Only 12% of those receiving non-invasive ventilation needed subsequent invasive ventilation via a tube, compared to 34% of those who had usual care.

This review identified 17 trials of adults with a severe acute exacerbation of COPD with high carbon dioxide levels. Trials compared usual care, including steroids and antibiotics with usual care plus non-invasive ventilation, which delivers air at high pressure via a mask. Airways are forced open and respiratory muscles can rest.

From the NIHR  Dissemination Centre

SPSC17: Physio suggests gaming technology could help treat adults with COPD

Canadian physiotherapist Dejan Preradovic has spoken about his research into the potential benefits of gaming technology for treating adults with chronic obstructive pulmonary disease (COPD) at the Scottish Physiotherapy Student Conference.

Effect of time and day of admission on hospital care quality for patients with chronic obstructive pulmonary disease exacerbation in England and Wales: single cohort study

BMJ Open. 2017 Sep 6;7(9):e015532. doi: 10.1136/bmjopen-2016-015532.

Increased mortality observed in weekend admissions is not easily explained by deficiencies in early clinical guideline care. Further study of out-of-hospital factors, specialty care and deaths later in the admission are required if effective interventions are to be made to reduce variation by day of the week of admission.

UHCW Research: C. Gelder

Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Int J Chron Obstruct Pulmon Dis. 2016 Jun 2;11:1161-9. doi: 10.2147/COPD.S91253. eCollection 2016.

Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.

SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.

UHCW Research: C. Gelder, V. Johnson-Warrington

Roflumilast for treating chronic obstructive pulmonary disease - guidance (TA461)

New NICE Technology Appraisal Guidance on using roflumilast (Daxas) for treating chronic obstructive pulmonary disease (COPD) in adults with chronic bronchitis.

Roflumilast, as an add-on to bronchodilator therapy, is recommended as an option for treating severe chronic obstructive pulmonary disease in adults with chronic bronchitis, only if:

• the disease is severe, defined as a forced expiratory volume in 1 second (FEV1) after a bronchodilator of less than 50% of predicted normal, and
• the person has had 2 or more exacerbations in the previous 12 months despite triple inhaled therapy with a long-acting muscarinic antagonist, a long-acting beta-2 agonist and an inhaled corticosteroid.

Clinical utility of alpha-1 proteinase inhibitor in the management of adult patients with severe alpha-1 antitrypsin deficiency: a review of the current literature

Drug Design, Development and Therapy. 14 July 2017 Volume 2017:11 Pages 2149—2162

Alpha-1 antitrypsin (AAT) functions primarily to inhibit neutrophil elastase, and its deficiency predisposes individuals to the development of chronic obstructive pulmonary disease (COPD). The putative protective serum concentration is generally considered to be above a threshold of 11 µM/L, and therapeutic augmentation of AAT above this value is believed to retard the progression of emphysema. Several AAT preparations, all derived from human donor plasma, have been commercialized since approval by the US Food and Drug Administration (FDA) in 1987. Biochemical efficacy has been demonstrated by augmentation of pulmonary antiprotease activity, but demonstration of clinical efficacy in randomized, placebo-controlled trials has been hampered by the practical difficulties of performing conventional studies in a rare disease with a relatively long natural history. Computed tomography has been applied to measure lung density as a more specific and sensitive surrogate outcome measure of emphysema than physiologic indices, such as forced expiratory volume in 1 second, and studies consistently show a therapeutic reduction in the rate of lung density decline. However, convincing evidence of benefit using traditional clinical measures remains elusive. Intravenous administration of AAT at a dose of 60 mg/kg/week is the commonest regime in use and has well-documented safety and tolerability. International and national guidelines on the management of AAT deficiency recommend intravenous augmentation therapy to supplement optimized usual COPD treatment in patients with severe deficiency and evidence of lung function impairment.
UHCW Research: David G Parr, Beatriz Lara

Influence of lung CT changes in chronic obstructive pulmonary disease (COPD) on the human lung microbiome

PLoS One. 2017 Jul 13;12(7):e0180859. doi: 10.1371/journal.pone.0180859. eCollection 2017.

Our findings indicate that CT detectable structural changes in the lung of COPD patients, which we termed severe subtypes, are associated with alterations in bacterial communities, which may induce further changes in the interaction between microbes and host cells. This might result in a changed interplay with the host immune system.

UHCW Research: Subramanian, D and Parr D.

NICE approves COPD treatment roflumilast for routine NHS use

Thousands of patients to benefit from roflumilast, also known as Daxas, to treat chronic obstructive pulmonary disease (COPD) after NICE says it should be more widely available.

Roflumilast is recommended as an option to treat adults with severe COPD whose symptoms continue to worsen despite other treatments. It is a once-a-day tablet that works to reduce irritation and swelling in airways of people with COPD.

Quantifying the ‘Lung at Risk’ in COPD: Does Emphysema Beget Emphysema?

Am J Respir Crit Care Med. 2017 Jun 13. doi: 10.1164/rccm.201705-0962ED. [Epub ahead of print]

UHCW Research: David G Parr

COPD report highlights concerning levels of hospital readmissions for patients in England

COPD: Who cares when it matters most? is a supplementary report detailing the outcomes of the cohort of patients included in the 2014 clinical audit of COPD exacerbations in England.

The report also demonstrates that, although COPD was the single most common cause of readmission, over 50% of readmissions were in older people with multiple health conditions. Many of the patients had also been admitted to hospital in the months prior to the audit.

Long-term oxygen therapy shows no benefit for moderate lung disease

Long-term oxygen therapy for 16 hours per day did not lengthen life or the time until hospital admission for people with stable chronic obstructive pulmonary disease (COPD) who experience a moderate drop in blood oxygen levels with exercise or at rest. Nor did it improve their quality of life, lung function or anxiety and depression scores.

From the NIHR Dissemination Centre

Physio makes respiratory MISSION possible

Called MISSION abc (which stands for modern innovative solutions improving outcomes in asthma, breathlessness and chronic obstructive pulmonary disease), the project has won two Healthcare News Journal awards, a patient safety award, and received local recognition.

Instead of waiting for at-risk patients to present at A&E or require unplanned care, the project identifies patients who are likely to benefit from a respiratory assessment via GP registers.

Behavioural and drug treatment together help those with lung disease stop smoking

Smokers with chronic obstructive pulmonary disorder (COPD) given drug treatment alongside behavioural therapy were more than twice as likely to stop smoking by six months as those given behavioural treatment alone. There was also some evidence that high intensity behavioural treatment is more effective than usual care or lower intensity therapy.

From the NIHR Dissemination Centre

GOLD 2017: Global Strategy for the Diagnosis, Management and Prevention of COPD

The GOLD report from the Global Initiative for Chronic Obstructive Lung Disease is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems.

Chronic obstructive pulmonary disease (COPD): indacaterol/glycopyrronium compared with salmeterol/fluticasone for reducing exacerbations

Medicines Evidence Commentary:
A 52-week, double-blind, randomised controlled trial (RCT) in people with moderate to severe COPD and a history of exacerbations found that the combination of indacaterol/glycopyrronium was superior to the combination of salmeterol/fluticasone in reducing exacerbations.

Potential alternative to painful blood tests in people with flare-ups of COPD

It may be possible to use venous blood and pulse oximeters to initially assess the severity of a flare up of chronic obstructive pulmonary disease (COPD). Blood gas levels were similar in people when testing blood from either arteries (the recommended test) or veins. Oxygen saturation using pulse oximeters – which attach to the end of the finger – were also reasonably accurate compared to testing arterial blood.

From the NIHR Dissemination Centre

Guide will help physios tackle malnutrition in COPD patients

Physiotherapists can now access a practical, evidence-based guide to managing malnutrition in adults with chronic obstructive pulmonary disease (COPD).  The resource aims to help healthcare professionals identify and manage people with the condition who are malnourished or at risk of disease-related malnutrition.