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NICE finalises guidance for hospitals to refer suspected COPD patients to their GP



NICE has signed off a new clinical guideline which will see hospitals referring patients with suspected chronic obstructive pulmonary disease (COPD) to their GP for spirometry testing.

The guidance recommends that primary care respiratory review and spirometry testing are considered for patients who are incidentally found to have signs of COPD on a chest X-ray or CT scan, including patients already under the care of general practice and those under secondary care. 

NICE argued that while this change will cause a small increase to GP workload, the additional spirometry referrals will have a ‘minimal resource impact’.

The recommendation forms part of the COPD in over 16s NICE guidance, published last week, and reported on in draft earlier this year.

The final guidelines said: ‘Consider primary care respiratory review and spirometry for people with emphysema or signs of chronic airways disease on a chest X-ray or CT scan.’

It added: ‘There may be a small number of additional referrals for spirometry, but this is expected to have a minimal resource impact.’

GPs previously argued that while GP-led spirometry is ‘reasonable’ if the patient was already under GP care, hospital specialists should arrange follow-ups themselves if the patient is already in secondary care.

Back in 2016, Pulse revealed that GPs would need to be certified and appear on a national register in order to perform spirometry, based on a new scheme implemented by NHS England.

But earlier this year, the BMA’s GP Committee said that while spirometry appeared as an item within the QOF, it is not part of GMS core contractual services and therefore local commissioners are responsible for setting training requirements.

NICE also released the final guidance on antibiotic prescribing for COPD this month, which called for antibiotics to be restricted and for GPs to only prescribe them for severe exacerbations.

Other recommendations from the latest guidance includes reviewing the choice of antibiotic being prescribed when microbiological results from a sputum sample become available.

COPD in over 16s recommendations in full:

Consider primary care respiratory review and spirometry for people with emphysema or signs of chronic airways disease on a chest X-ray or CT scan. [2018]

If the person is a current smoker, their spirometry results are normal and they have no symptoms or signs of respiratory disease:

  • offer smoking cessation advice and treatment, and referral to specialist stop smoking services (see the NICE guideline on stop smoking interventions and services)
  • warn them that they are at higher risk of lung disease
  • advise them to return if they develop respiratory symptoms
  • be aware that the presence of emphysema on a CT scan is an independent risk factor for lung cancer. [2018]

If the person is not a current smoker, their spirometry is normal and they have no symptoms or signs of respiratory disease:

  • ask them if they have a personal or family history of lung or liver disease and consider alternative diagnoses, such as alpha-1 antitrypsin deficiency
  • reassure them that their emphysema or chronic airways disease is unlikely to get worse
  • advise them to return if they develop respiratory symptoms
  • be aware that the presence of emphysema on a CT scan is an independent risk factor for lung cancer. [2018]

Source: NICE