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CHED EIJHKJLCHED EIJHKJL FKEDHO II D FKEDHO II DEELLH 16I: =DEII D D=DJH 16I: =DEII D D=DJ
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KI: 23 KD 2010
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© NICE 2010. All rights reserved.
http://nice.org.uk/guidance/cg101http://nice.org.uk/guidance/cg101
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CEDJDJICEDJDJI
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1.2 D=D= IJ C...................................................................................................................................................... 18
1.3 D=DJ E NHJEDI E C .................................................................................................................... 35
2 EJI ED J IEF E J =KD .................................................................................................................... 45
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4.1 KEDHO HJJED KHD= EIFJ IIED ............................................................................................. 47
4.2 KJDIED IIIIDJ E EKJEI ............................................................................................................... 47
4.3 HF JHFO ......................................................................................................................................................................... 48
4.4 KEOJ JHFO ................................................................................................................................................................ 48
5 JH LHIEDI E JI =KD............................................................................................................................ 49
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5.2 DEHJED EH J FK ................................................................................................................................................. 49
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AFFDN A: #KD LEFDJ #HEKF.............................................................................................. 52
2010 =KD KFJ LEFDJ =HEKF HI ................................................................................................. 52
DLJ NFHJ ................................................................................................................................................................................ 53
FKJI........................................................................................................................................................................................... 54
2004 D =KD 12 LEFDJ =HEKF HI ........................................................................................... 54
CEDIDIKI HD #HEKF................................................................................................................................................... 55
Chronic obstructive pulmonary disease (CG101)
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AFFDN B: #KD LM D............................................................................................................. 57
2010 =KD KFJ #KD LM D.............................................................................................................. 57
2004 D =KD 12 #KD LM D........................................................................................................ 57
AFFDN C: =EHJI....................................................................................................................................... 59
AEKJ JI =KD ...................................................................................................................................................... 60
Chronic obstructive pulmonary disease (CG101)
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I =KD HFI C#12.
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1$JH CEIIED (2006) CHD= J H: DJED IJKO E HED EIJHKJL
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JDJ-DJH HJDJ-DJH H
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http://www.dh.gov.uk/en/DH_103643http://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.wales.nhs.uk/consenthttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007005http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007005http://www.wales.nhs.uk/consenthttp://www.justice.gov.uk/protecting-the-vulnerable/mental-capacity-acthttp://www.dh.gov.uk/en/DH_103643
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http://www.nice.org.ukguidance/CG101/evidencehttp://www.nice.org.ukguidance/CG101/evidence
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KIFJ ILH C CEDWH =DEII D EFJI JHFO
FJDJ HGKIJI IED EFDED CEDWH =DEII D EFJI JHFO
DIJ E EH FKED CEDWH =DEII D EFJI JHFO
AIIIIDJ EH ENO=D JHFO FJI JHFO D IKH EE =II
AIIIIDJ EH ED=-JH DKIH
JHFO
FJI JHFO D NK DFFHEFHJ
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A HF D D "!1 !DEKH= HO DJHLDJED
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DJO DJI EH FKEDHO HJJED
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IKH=HO
DJO DJI EH IKH=HO
AIIIIDJ EH KD= JHDIFDJJED DJO DJI EH IKH=HO
OIKDJED HJD= CEDWH =DEII, EFJI FHEJHFO D
II EJH JHFIJI
DIJ E IOFJEI KDH 40 OHI EH
O IJEHO E F-1 DJJHOFID
WDO
DJO F-1 DJJHOFID WDO, EDIH
JHFO D IHD O
DHJD =DEII =DEII
Chronic obstructive pulmonary disease (CG101)
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OFJEI IFHEFEHJEDJ JE KD=
KDJED WJ
EE EH EJH NFDJEDI DKD= H
FHDJ, FKEDHO OFHJDIED, FHIIED
D OFHLDJJED
"HGKDJ DJEDI !NK HEDJII
$EFJOII !NK HDE E J HEDKI
1.1.8.2 JDJI ME H HHH E DEJ MOI L JE ID O HIFHJEHO
FOID. D IE II JO O ID O HI E J C J ME
L FFHEFHJ JHDD= D NFHJI. 20042004
1.2 Managing stable COPD
1.2.11.2.1 ED= IIJEDED= IIJED
1.2.1.1 AD KF-JE-J IED= IJEHO, DKD= F OHI IE (DKH E
=HJJI IE FH O, L O 20, KJF O J DKH E OHI
IE), IEK EKDJ EH LHOED MJ C. 20042004
1.2.1.2 A C FJDJI IJ IED=, H=HII E =, IEK DEKH= JE IJEF,
D EH F JE E IE, J LHO EFFEHJKDJO. 20042004
1.2.1.3 DII EDJHDJ, EH , LHDD EH KFHEFED, I FFHEFHJ, JE
FEF ME H FDDD= JE IJEF IED= ED MJ D FFHEFHJ IKFFEHJ
FHE=H JE EFJI IED= GKJ HJI EH FEF MJ C5
. 20102010
EEMD= JME HEDJEDI H HE 'HDD EH IED= IIJED' (C!
JDEE=O FFHI =KD 123).
1.2.1.4 HDD I HED MJD JI DI DJEDI I D EFJED EH
IEHI ME L NFHII IH JE GKJ IED=. 20072007
1.2.1.5 HDD IEK DEHO FHIH EDO I FHJ E FHE=H E
LEKH IKFFEHJ. 20072007
1.2.21.2.2 D JHD JHFFOO
EHJ-JD= J2 =EDIJI (ABA) D IEHJ-JD= KIHD DJ=EDIJI (AA)EHJ-JD= J2 =EDIJI (ABA) D IEHJ-JD= KIHD DJ=EDIJI (AA)
Chronic obstructive pulmonary disease (CG101)
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1.2.2.1 EHJ-JD= HEDEJEHI, I DIIHO, IEK J DJ FH
JHJDJ EH J H E HJIIDII D NHI JJED. 20042004
D EHJEIJHEID EHJEIJHEI
1.2.2.2 H EHJEIJHE HLHIJO JIJI E DEJ FHJ HIFEDI JE D
EHJEIJHE JHFO D IEK DEJ KI JE DJO M FJDJI IEK
FHIH D EHJEIJHEI. 20042004
1.2.2.3 B MH E J FEJDJ HI E LEFD= I JI (DKD= DED-J
FDKED) D FEF MJ C JHJ MJ D EHJEIJHEI D
FHFH JE IKII MJ FJDJI. DM 2010DM 2010
D EDJED JHD EDJED JHFFOO
I IJED FHELI HEDJEDI ED J IGKD E D JHFI EH FEF MJ
IJ C. I HEDJEDI H IE =LD D =H EH D =EHJ 2 (I FFDN
C).
1.2.2.4 JLDII E HEDEJEH JHFO IEK DEJ IIII O KD=
KDJED ED KJ IEK DK LHJO E EJH IKHI IK IFHELDJ D IOFJEI, JLJI E O LD=, NHI FJO, D
HFJO E IOFJE H. 20042004
1.2.2.5 H ED-O ED=-JD= KIHD DJ=EDIJ (AA) D FHHD JE
EKH-JI-O IEHJ-JD= KIHD DJ=EDIJ (AA) JE FEF MJ
IJ C ME HD HJII EH L NHJEDI IFJ KID= IEHJ-
JD= HEDEJEHI I HGKH, D D ME IED I D JE
ED H=KH DJDD HEDEJEH JHFO MJ KIHD
DJ=EDIJ6
. DM 2010DM 2010
1.2.2.6 D FEF MJ IJ C ME HD HJII EH L NHJEDI
IFJ KID= IEHJ-JD= HEDEJEHI I HGKH, EH J EEMD= I
DJDD JHFO:
"!1 V 50% FHJ: JH ED=-JD= J2 =EDIJ (ABA) EH AA
"!1 < 50% FHJ: JH ABA MJ D D EHJEIJHE (C) D EDJED DH, EH AA. DM 2010DM 2010
Chronic obstructive pulmonary disease (CG101)
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1.2.2.7 D FEF MJ IJ C D D "!1 V 50% ME HD HJII EH L
NHJEDI IFJ DJDD JHFO MJ ABA:
EDIH ABA+C D EDJED DH
EDIH AA D JED JE ABA MH C I D EH DEJ JEHJ. DM 2010DM 2010
1.2.2.8 H AA D JED JE ABA+C JE FEF MJ C ME HD
HJII EH L NHJEDI IFJ JD= ABA+C, HHIFJL E JH
"!1. DM 2010DM 2010
1.2.2.9 CEDIH ABA+C D EDJED DH D JED JE AA EH FEF
MJ IJ C ME HD HJII EH L NHJEDI IFJ
DJDD JHFO MJ AA HHIFJL E JH "!1. DM 2010DM 2010
1.2.2.10 E E HK=(I) IEK J DJE EKDJ J FHIED'I IOFJEJ
HIFEDI D FHHD, D J HK='I FEJDJ JE HK NHJEDI, JI
I JI D EIJ. 20102010
LLHO IOIJI KI JE JHJ FJDJI MJ IJ CHO IOIJI KI JE JHJ FJDJI MJ IJ C
EIJ FJDJI S MJLH JH = S H JE GKH D DJD GKJ DH JDGK
=LD GKJ DIJHKJED. NFJED JE JI I JJ JEI MJ I=DWDJ E=DJL FHDJ
(I =KD, JEI MJ $EDIED AHLJ DJ IJ EH E 4 EH II) H KD JE
KI DO EH E DH L. D EIJ FJDJI, EMLH, FH=J FFHE =K O
DLK FJDJ IIIIDJ I D D EEID= L.
DHIDHI
1.2.2.11 D EIJ II HEDEJEH JHFO I IJ DIJH KID= D-DH L (DKD= IFH L FFHEFHJ). 20042004
1.2.2.12 J FJDJ I KD JE KI FHJKH L IJIJEHO, J I DEJ IKJ
EH EH H, D D JHDJL IEK EKD. 20042004
1.2.2.13 DHI IEK FHIH EDO JH FJDJI L HL JHDD= D J
KI E J L D L EDIJHJ IJIJEHO JDGK. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.2.14 JDJI IEK L JH JO JE KI D DH L H=KHO IIII O
EFJDJ JH FHEIIED D, DIIHO, IEK H-JK=J J
EHHJ JDGK. 20042004
FHIFHI
1.2.2.15 IFH IEK EFJ MJ J FJDJ'I JH-EI DH.
20042004
1.2.2.16 J I HED JJ IFHI H KI D J EEMD= MO:
J HK= I DIJH O HFJ ID= JKJEDI E J JH-EI DH
DJE J IFH, MJ EEM O DJED
JH IEK D O JMD DH JKJED D DJED
J HJD= D KI I J I I JL I ID= HJI. 20042004
1.2.2.17 FHI IEK D DE EH JD EDJO I EH HGKDJ DD=
JI JH FHEHD (KI E K KF E IJJ). O IEK
D MJ MJH D MID=-KF GK D EM JE H HO.
EKJF IEK MF D E JH=DJ EH KI. 20042004
KIHIKIHI
1.2.2.18 JDJI MJ IJHIID= EH ID= HJIIDII IFJ N JHFO
KID= DHI IEK EDIH EH DKIH JHFO. 20042004
1.2.2.19 KI JHFO IEK DEJ EDJDK JE FHIH MJEKJ IIIID= D
EDWHD= JJ ED EH EH E J EEMD= EKHI:
HKJED D IOFJEI
D DHI D J JO JE KDHJ JLJI E O LD=
D DHI D NHI FJO
D FHELDJ D KD= KDJED. 20042004
1.2.2.20 KI JHFO IEK DEJ FHIH MJEKJ D IIIIDJ E JFJDJ'I D/EH HH'I JO JE KI J. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.2.21 A DKIH IOIJ JJ I DEMD JE WDJ IEK KI. D L,
CEJR !KHEFD EHIJED (!KHEFD CEJJ EH JDHIJED,
C!) J IEK KI JE IIII WDO. 20042004
1.2.2.22 JDJI IEK EH E JMD I D EKJF JE
DIJH JH DKI JHFO, KDII J HK= IFWO HGKHI
EKJF (EH NF, DJEDH= HK=I). 20042004
1.2.2.23 DKIH JHFO I FHIH, J FJDJ IEK FHEL MJ
GKFDJ, IHLD=, L D IKFFEHJ. 20042004
1.2.31.2.3 HH JH JHFFOO
HH EHJEIJHEI EHJEIJHEI
1.2.3.1 DJDD KI E EH EHJEIJHE JHFO D C I DEJ DEHO
HED. E FJDJI MJ LD C O HGKH DJDD
EH EHJEIJHEI MD JI DDEJ MJHMD EEMD= D
NHJED. D JI II, J EI E EH EHJEIJHEI IEK FJ I
EM I FEII. 20042004
1.2.3.2 JDJI JHJ MJ ED=-JH EH EHJEIJHE JHFO IEK
EDJEH EH J LEFDJ E EIJEFEHEII D =LD FFHEFHJ
FHEFONI. JDJI ELH J = E 65 IEK IJHJ ED FHEFOJ
JHJDJ, MJEKJ EDJEHD=. 20042004
HH JEF JEFODOD
D JI IJED E J =KD, J JH JEFOD I KI JE D IEM-HI EHKJEDI E
JI HK=.
1.2.3.3 EFOD IEK EDO KI JH JH E IEHJ-JD= HEDEJEHI
D ED=-JD= HEDEJEHI, EH D FJDJI ME H KD JE KI D
JHFO, I JH I D JE EDJEH FI LI D DJHJEDI. 20042004
1.2.3.4 HJKH KJED DI JE JD MJ J KI E JEFOD D EH FEF
KI E HDI D FHEDJI, J DHI EE E
EEHJI D J KI E EJH JEDI. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.3.5 JLDII E J JHJDJ MJ JEFOD IEK IIII O
FHELDJI D IOFJEI, JLJI E O LD=, NHI FJO D KD=
KDJED. 20042004
1.2.3.6 EI E JEFOD FHIH IEK HK J J J E D
NHJED HE EH XKHEGKDEED DJEJI (EH EJH HK=I DEMD JE
DJHJ) H FHIH. 20042004
HH KEOJ JH KEOJ JHFFOO
1.2.3.7 KEOJ HK= JHFO IEK EDIH D FJDJI MJ HED EK=
FHEKJL E IFKJK. 20042004
1.2.3.8 KEOJ JHFO IEK EDJDK JH I IOFJEJ FHELDJ
(EH NF, HKJED D HGKDO E EK= D IFKJK FHEKJED). 20042004
1.2.3.9 E DEJ HEKJDO KI KEOJ HK=I JE FHLDJ NHJEDI D FEF MJ
IJ C. DM 2010DM 2010
HH DJ-E DJ-ENDJ JHNDJ JHFFOO
1.2.3.10 HJDJ MJ F-JEEFHE D J-HEJD IKFFDJI, ED EH D
EDJED, I DEJ HED. 20042004
ADJ-JKIILADJ-JKIIL JH JHFFOO
1.2.3.11 ADJ-JKIIL JHFO IEK DEJ KI D J D=DJ E IJ C.
20042004
HH FHEF FHEFOJ DJEJ JHOJ DJEJ JHFFOO
1.2.3.12 H I DIKWDJ LD JE HED FHEFOJ DJEJ JHFO D
J D=DJ E IJ C. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.41.2.4 CED EHCED EH D D JH D D JHFFOO
1.2.4.1 FJDJI HD IOFJEJ ED EDEJHFO, JH JHJDJ IEK
DJDIW O EDD= JHFI HE HDJ HK= III. !JL
EDJEDI DK:
J2 =EDIJ D JEFOD
DJEDH= D JEFOD. 20042004
1.2.51.2.5 NO=DNO=D
ED=-JH EED=-JH ENO=D JHNO=D JHFFO (O ())
1.2.5.1 CDDI IEK MH JJ DFFHEFHJ ENO=D JHFO D FEF MJ
C O KI HIFHJEHO FHIIED. 20042004
1.2.5.2 I DJ D FJDJI MJ C ME L 2 II JD 7.3
MD IJ EH 2 =HJH JD 7.3 D II JD 8 MD IJ D ED
E: IEDHO FEOOJ, DEJKHD OFEN (ENO=D IJKHJED E
HJH EE 2 II JD 90% EH EH JD 30% E J J), FHFH
E EH FKEDHO OFHJDIED. 20042004
1.2.5.3 E =J J DWJI E FJDJI IEK HJ IKFFDJ ENO=D EH J
IJ 15 EKHI FH O. #HJH DWJI H ID D FJDJI HLD= ENO=D
EH 20 EKHI FH O. 20042004
1.2.5.4 D EH ENO=D JHFO IEK IIII D:
FJDJI MJ LHO ILH HXEM EIJHKJED ("!1 < 30% FHJ)
FJDJI MJ ODEII
FJDJI MJ FEOOJ
FJDJI MJ FHFH E
FJDJI MJ HI K=KH LDEKI FHIIKH
FJDJI MJ ENO=D IJKHJEDI U 92% HJD= H.
Chronic obstructive pulmonary disease (CG101)
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AIIIIDJ IEK IE EDIH D FJDJI MJ ILH HXEM EIJHKJED
("!1 30S49% FHJ). 20042004
1.2.5.5 E DIKH FJDJI = EH H DJW, FKI ENJHO IEK
L D JH IJJD=I. 20042004
1.2.5.6 IIIIDJ E FJDJI EH IEK EFHI J IKHDJ E
HJH EE =II ED JME EIEDI J IJ 3 MI FHJ D FJDJI ME
L EDWDJ =DEII E C, ME H HLD= EFJK
D=DJ D MEI C I IJ. 20042004
1.2.5.7 JDJI HLD= IEK HLM J IJ ED FH OH O
FHJJEDHI H MJ D JI HLM IEK DK FKI ENJHO.20042004
1.2.5.8 NO=D EDDJHJEHI IEK KI JE FHEL J WN IKFFO J E EH
ED=-JH ENO=D JHFO. 20042004
1.2.5.9 JDJI IEK MHD EKJ J HII E WH D NFEIED JO EDJDK
JE IE MD FHIH ENO=D. 20042004
AKJEHO EAKJEHO ENO=D JHNO=D JHFFOO
1.2.5.10 EF ME H HO ED ME MI JE EDJDK MJ ENO=D JHFO
EKJI J E, D ME H FHFH JE KI J, IEK L KJEHO
ENO=D FHIH. 20042004
1.2.5.11 AKJEHO ENO=D JHFO IEK EDIH D FJDJI ME L NHI
IJKHJED, H IEMD JE L D FHELDJ D NHI FJO D/EH
OIFDE MJ ENO=D, D L J EJLJED JE KI ENO=D. 20042004
1.2.5.12 AKJEHO ENO=D JHFO I DEJ HED D C 2 I =HJH
JD 7.3 D JH I DE NHI IJKHJED. 20042004
1.2.5.13 AKJEHO ENO=D JHFO IEK EDO FHIH JH D FFHEFHJ
IIIIDJ I D FHEH O IFIJ. FKHFEI E J IIIIDJ
I JE IIII J NJDJ E IJKHJED, D J FHELDJ D NHI FJO
MJ IKFFDJ ENO=D, D J ENO=D XEM HJ HGKH JE EHHJIJKHJED. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.5.14 =J-M=J ODHI, ENO=D-EDIHLD= LI D FEHJ GK
ENO=D IOIJI IEK L EH J JHJDJ E FJDJI MJ C.
20042004
1.2.5.15 A E EKJ J DJKH E GKFDJ FHIH IEK J EKDJ E J
EKHI E KJEHO ENO=D KI HGKH O J FJDJ D J ENO=D XEM
HJ HGKH. 20042004
EHJ-KHIJ EEHJ-KHIJ ENO=D JHNO=D JHFFOO
1.2.5.16 EHJ-KHIJ ENO=D JHFO IEK EDO EDIH EH FIEI E ILH
HJIIDII D FJDJI MJ C DEJ HL O EJH JHJDJI. 20042004
1.2.5.17 EHJ-KHIJ ENO=D JHFO IEK EDO EDJDK JE FHIH D
FHELDJ D HJIIDII EEMD= JHFO I D EKDJ. 20042004
1.2.5.18 D DJ, IEHJ-KHIJ ENO=D IEK FHEL HE ODHI. 20042004
1.2.61.2.6 ED-DED-DLILLIL L LDJJEDDJJED
1.2.6.1 AGKJO JHJ FJDJI MJ HED OFHFD HIFHJEHO KH ME
L HGKH IIIJ LDJJED (MJH DLIL EH DED-DLIL) KHD= D
NHJED EH ME H OFHFD EH EJ ED IEK HHH JE
IFIJ DJH EH EDIHJED E ED=-JH . 20042004
1.2.71.2.7 D=DJ E FKEDHO D=DJ E FKEDHO OFHJDIED D EH FKEDOFHJDIED D EH FKED
D J EDJNJ E JI =KD, J JH 'EH FKED' I D EFJ JE WD D
EDJED JJ I DJW D D= ED J II E D JKHI. I D IODHE E
EH FKED DKI FJDJI ME L H=J HJ KH IEDHO JE KD= II D JEI DME J FHHO FJEE=O I HJDJED E IJ D MJH, D= JE J LEFDJ E
FHFH E.
=DEII E FKEDHO =DEII E FKEDHO OFHJDIED D EH FKEDOFHJDIED D EH FKED
1.2.7.1 A =DEII E EH FKED IEK EDIH FJDJI L:
FHFH E
Chronic obstructive pulmonary disease (CG101)
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HI LDEKI FHIIKH
IOIJE FHIJHD L
EK FKEDHO IED HJ IEKD. 20042004
1.2.7.2 J I HED JJ J =DEII E EH FKED I DO D
JJ JI FHEII IEK DLEL NKD= EJH KII E FHFH E.
20042004
HJDJ E EH FKEDHJDJ E EH FKED
1.2.7.3 JDJI FHIDJD= MJ EH FKED IEK IIII EH J D EH
ED=-JH ENO=D JHFO. 20042004
1.2.7.4 IIEJ MJ EH FKED D KIKO EDJHE
IOFJEJO MJ KHJ JHFO. 20042004
1.2.7.5 EEMD= H DEJ HED EH J JHJDJ E EH FKED:
D=EJDID-EDLHJD= DPO DJEHI
K DD EHI
F-EHI
=END (KDII JH I JH WHJED). 20042004
1.2.81.2.8 KEDHO HJJEDKEDHO HJJED
KEDHO HJJED I WD I KJIFDHO FHE=H E H EH FJDJI MJ
HED HIFHJEHO FHDJ JJ I DLKO JEH D I=D JE EFJI FJDJ'IFOI D IE FHEHD D KJEDEO.
1.2.8.1 KEDHO HJJED IEK L JE FFHEFHJ FEF
MJ C (I 1.2.8.2) DKD= JEI ME L HDJ EIFJIJED
EH D KJ NHJED. DM 2010DM 2010
1.2.8.2 KEDHO HJJED IEK EH JE FJDJI ME EDIH
JILI KDJEDO I O C (KIKO C =H 3 D EL).
Chronic obstructive pulmonary disease (CG101)
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KEDHO HJJED I DEJ IKJ EH FJDJI ME H KD JE M,
L KDIJ D=D EH ME L HDJ OEH DHJED. 20042004
1.2.8.3 "EH FKEDHO HJJED FHE=HI JE JL, D JE FHEL
EDEHD, JO IEK J JI JJ IKJ FJDJI, D D KD=I
JJ H IO EH FJDJI JE =J JE D L =EE II EH FEF MJ
IJI. I IEK L MJD HIED J E HHH.
20042004
1.2.8.4 KEDHO HJJED FHE=HI IEK DK KJEFEDDJ,
KJIFDHO DJHLDJEDI, M H JEH JE J DLK FJDJ'I
DI. HJJED FHEII IEK DEHFEHJ FHE=H E FOI
JHDD=, II KJED, DKJHJED, FIOEE= D LEKHDJHLDJED. 20042004
1.2.8.5 JDJI IEK MH E J DWJI E FKEDHO HJJED D
J EJDJ HGKH JE =D JI. 20042004
1.2.91.2.9 DJED D DJ-LHDJED D DJ-LH JH JHFFOO
1.2.9.1 DKEE LDJED D D DDK DXKDP LDJED IEK
EH JE FJDJI MJ C I HED O J C
WH7
. 20042004
1.2.101.2.10 KD= IKH=HOKD= IKH=HO
1.2.10.1 JDJI ME H HJII, D L ID= H= K ED C ID D D
"!1 II JD 50% FHJ IEK HHH EH EDIHJED E
KJEO. 20042004
1.2.10.2 JDJI MJ ILH C ME HD HJII MJ H HIJHJEDI E
JH JLJI E O LD=, IFJ N JHFO (DKD=
HJJED), IEK HHH EH EDIHJED E KD= LEK HKJED
IKH=HO JO J E J EEMD= HJH:
"!1 EH JD 20% FHJ
C2 II JD 7.3
Chronic obstructive pulmonary disease (CG101)
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KFFH E FHEDDJ FOI
C EH JD 20% FHJ. 20042004
1.2.10.3 JDJI MJ ILH C ME HD HJII MJ H HIJHJEDI E
JH JLJI E O LD= IFJ N JHFO IEK
EDIH EH HHH EH IIIIDJ EH KD= JHDIFDJJED HD= D D
EEHJI D E IKH= FHEJEEI. CEDIHJEDI DK:
=
"!1
C2
EE=DEKIO IJHKJ FOI ED C ID
LJ FKEDHO HJHO FHIIKHI MJ FHE=HIIL JHEHJED. 20042004
1.2.111.2.11 AF-1 DJJHOFID HFDJ JHAF-1 DJJHOFID HFDJ JHFFOO
1.2.11.1 AF-1 DJJHOFID HFDJ JHFO I DEJ HED EH FJDJI MJ
F-1 DJJHOFID WDO (I IE HEDJED 1.1.3.3). 20042004
1.2.121.2.12 KJIFDHO D=DJKJIFDHO D=DJ
DO E JI JLJI O KDHJD D J D EH D J FHJ I FHJ E HEKJD H O
J FHJJEDH ID= J FJDJ KJ D HJD HKIJDI J FJDJ O D JE HHH
JE IFIJ FHJDJ, EH NF, FOIEJHFO. KJIFDHO MEHD= DI HD=
EMD IJEH HJED E HEI KI DO E J JLJI D D=D= C D
KDHJD O DLKI HE HDJ FHEIIED =HEKDI. CEFJDI H EH
FEHJDJ JD FHEIIED EKDHI.
1.2.12.1 C H IEK LH O KJIFDHO J. 20042004
1.2.12.2 EEMD= KDJEDI IEK EDIH MD WDD= J JLJO E J
KJIFDHO J:
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J D EH I EH O LD= D J FFHEFHJDII E LHO IOIJI EH
D JHFO)
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H D JHJDJ E FJDJI (DKD= DED-DLIL LDJJED, FKEDHO
HJJED, EIFJ-J-E/HO IH= II, FHELD= FJL H,
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JLJI M JE LE H=DO IIEDI
LID= FJDJI ED NHI
KJED E FJDJI D EJH J FHEIIEDI. 20042004
IFHIFHJEHO DKHI IFIJIJEHO DKHI IFIJI
1.2.12.3 J I HED JJ HIFHJEHO DKHI IFIJI EH FHJ E J
KJIFDHO C J. 20042004
OIEJHOIEJHFFOO
1.2.12.4 FJDJI L NIIL IFKJK, JO IEK JK=J:
J KI E FEIJL NFHJEHO FHIIKH II
JL O E HJD= JDGKI. 20042004
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ME L D ID J EH JJ JE EIFJ MJ D NHJED E C. 20042004
H JE 'FHIIED D KJI MJ HED FOI J FHE' (C! D
Chronic obstructive pulmonary disease (CG101)
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=KD 91), M KFJI J HEDJEDI ED J JHJDJ E FHIIED D
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D EH FJDJI JJDJED IEK IE F JE D=I D M=J, FHJKHO
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MJ D-IJ= C M I KDHIFEDIL JE EJH JHFO. 20042004
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IJ= C KDHIFEDIL JE EJH JHFO. 20042004
1.2.12.10JDJI MJ D-IJ= C D JH O D HHI IEK L II JE
J K HD= E IHLI EH O KJIFDHO FJL H JI,
DKD= IIED JE EIFI. 20042004
AIIIIDJ EH EKFJED JHAIIIIDJ EH EKFJED JHFFOO
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O LD= D EM HJII JO E MD ED= JI. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.12.12CDDI DLEL D J H E FEF MJ C IEK IIII JH D EH
EKFJED JHFO KID= LJ JEEI. 20042004
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1.2.12.13JDJI I O C IEK EDIH EH HHH EH IIIIDJ O
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1.2.12.15A FJDJI MJ D "!1 < 50% FHJ ME H FDDD= H JHL IEK
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JEHJO DHI HI E LEFD= FDKEJEHN KHD= H JHL.
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IJ JE KJED FHE=HI. HE=HI I=D EH IJ IEK DEJ
KI D C. 20042004
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K==IJ JEFI EH DKIED H IJ D FFDN C E J K =KD (I
IJED 5 EH JI E J K =KD).
F=I IEK J EKDJ E J HDJ DI E FJDJI J HDJ IJ=I
E JH II. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.2.12.20JDJI MJ EHJ D ILH C IEK MH E J
JDGK E . JI DWJI D JJEDI IEK NFD IE JJ J I
LH DIIHO D J KJKH JO M MH E JI IIKI (I
IJED 1.3.7). 20042004
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D=DJ L JJ DEKH=I J JE HIFED FHEFJO JE J
IOFJEI E D NHJED. 20042004
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NHJED O:
IJHJD= EH EHJEIJHE JHFO JH DHI HJIIDII DJHHI MJ
JLJI E O LD= (KDII EDJHDJ)
IJHJD= DJEJ JHFO JH IFKJK I FKHKDJ
KIJD= JH HEDEJEH JHFO JE EDJHE JH IOFJEI. 20042004
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D=DJ IJHJ=O (I HEDJED 1.3.5.9). 20042004
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1.2.13.2 J I HED JJ KD= KDJED IEK DEJ J EDO HJHED KI JE
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IIKI IJ D J 6. 20042004
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DLIL LDJJED IEK HLM H=KHO O IFIJI. 20042004
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/EH/EHJ/IJ/ILLH (IJ=I 1 JEH (IJ=I 1 JE
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Chronic obstructive pulmonary disease (CG101)
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1.3.11.3.1 WDJED E D WDJED E D NHJEDNHJED
AD NHJED I IKIJD MEHIDD= E J FJDJ'I IOFJEI HE JH KIK IJ IJJ
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H MEHIDD= HJIIDII, EK=, DHI IFKJK FHEKJED D D= D IFKJK EEKH. D= D JI IOFJEI EJD DIIJJI D= D JED.
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Chronic obstructive pulmonary disease (CG101)
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2 < 90% E I
CD=I ED IJ HE=HF E HIDJ
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=DEII E D NHJED I DO D EI DEJ FD ED J HIKJI E
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JD JE L EH ILH NHJEDI) D JEI D J EKDJO.
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JDJI HHH JE EIFJJDJI HHH JE EIFJ
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IJ HE=HF IEK EJD
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Chronic obstructive pulmonary disease (CG101)
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EE KJKHI IEK JD J FJDJ I FOHN. 20042004
1.3.41.3.4 $EIFJ-J-E D IIIJ-IH= II$EIFJ-J-E D IIIJ-IH= II
1.3.4.1 $EIFJ-J-E D IIIJ-IH= II H I D JL DIEK KI I D JHDJL MO E HD= EH FJDJI MJ NHJEDI E
C ME MEK EJHMI D JE JJ EH IJO D EIFJ. 20042004
1.3.4.2 KJ-FHEIIED J HGKH JE EFHJ JI II IEK DK
J FHEIIEDI MJ NFHD D D=D= C, D O DK
DKHII, FOIEJHFIJI, EKFJED JHFIJI D =DH J MEHHI.
20042004
1.3.4.3 H H KHHDJO DIKWDJ J JE WH HEDJEDI EKJ
M FJDJI MJ D NHJED H EIJ IKJ EH EIFJ-J-E EH
HO IH=. JDJ IJED IEK FD ED J HIEKHI L D
ID E JEHI IIEJ MJ MEHI FHE=DEII, EH NF, EII.
20042004
1.3.4.4 JDJI' FHHDI EKJ JHJDJ J E EH D EIFJ IEK
EDIH. 20042004
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DHI HJIIDII I EED JKH E D NHJED E C. I I KIKO D=
O JD= DHI EII E IEHJ-JD= HEDEJEHI.
LLHO IOIJI EH D JHHO IOIJI EH D JHFFO KHD= O KHD= NHJEDINHJEDI
1.3.5.1 BEJ DKIHI D D- DHI D KI JE DIJH DJHFO KHD= NHJEDI E C. 20042004
1.3.5.2 E E LHO IOIJ IEK HXJ J EI E HK= HGKH, J
JO E J FJDJ JE KI J L D J HIEKHI L JE IKFHLI
J DIJHJED E J JHFO. 20042004
1.3.5.3 JDJI IEK D= JE D- DHI I IEED I JH EDJED I
IJI KI JI O FHJ HH IH= HE EIFJ. 20042004
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1.3.5.4 FJDJ I OFHFD EH EJ J DKIH IEK HLD O
EFHII H, DEJ ENO=D (JE LE MEHIDD= OFHFD). ENO=D JHFO
I D J IEK DIJH IKJDEKIO O DI DDK. 20042004
1.3.5.5 HLD= =I EH DKI JHFO IEK MOI IFW D J
FHIHFJED. 20042004
OIJ EHJEIJHEIOIJ EHJEIJHEI
1.3.5.6 D J ID E I=DWDJ EDJHDJEDI EH EHJEIJHEI IEK
KI, D EDKDJED MJ EJH JHFI, D FJDJI JJ JE EIFJ
MJ D NHJED E C. 20042004
1.3.5.7 D J ID E I=DWDJ EDJHDJEDI, EH EHJEIJHEI IEK
EDIH D FJDJI D J EKDJO ME L D NHJED MJ
I=DWDJ DHI D HJIIDII M DJHHI MJ O JLJI.
20042004
1.3.5.8 JDJI HGKHD= EHJEIJHE JHFO IEK DEKH= JE FHIDJ HO
JE =J NK DWJI (I HEDJEDI 1.2.12.21S25). 20042004
1.3.5.9 HDIEED 30 = EHO IEK FHIH EH 7 JE 14 OI. 20042004
1.3.5.10 J I HED JJ EKHI E EHJEIJHE JHJDJ IEK DEJ
ED=H JD 14 OI I JH I DE LDJ= D FHEED= JHFO. 20042004
1.3.5.11 "EH =KD ED IJEFFD= EH EHJEIJHE JHFO J I HED JJ
DDI HH JE J 'BHJI DJED EHKHO' IJED 6.3.2. 20042004
1.3.5.12 IJEFEHEII FHEFONI IEK EDIH D FJDJI HGKHD= HGKDJ
EKHII E EH EHJEIJHEI. 20042004
1.3.5.13 JDJI IEK MH E J EFJK KHJED E JHJDJ D J
LHI JI E FHEED= JHFO. 20042004
1.3.5.14 JDJI, FHJKHO JEI IH= HE EIFJ, IEK =LD H
DIJHKJEDI EKJ MO, MD D EM JE IJEF JH EHJEIJHE JHJDJ.
20042004
Chronic obstructive pulmonary disease (CG101)
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ADJEJIADJEJI
1.3.5.15 ADJEJI IEK KI JE JHJ NHJEDI E C IIEJ MJ
IJEHO E EH FKHKDJ IFKJK. 20042004
1.3.5.16 JDJI MJ NHJEDI MJEKJ EH FKHKDJ IFKJK E DEJ D
DJEJ JHFO KDII JH I EDIEJED ED IJ HE=HF EH D
I=DI E FDKED. 20042004
1.3.5.17 DJ FH JHJDJ IEK D DEFDD, HE, EH
JJHOD. D DJJD= FH DJEJ JHJDJ FHIHHI IEK
MOI J EKDJ E DO =KD IIK O JH E HEEE=IJI. 20042004
1.3.5.18 D IFKJK I D IDJ EH KJKH, J FFHEFHJDII E DJEJ
JHJDJ IEK =DIJ EHJEHO KJKH D IDIJLJI MD
JO E L. 20042004
EFEFOD D EJH JOD D EJH JONDJDIONDJDI
1.3.5.19 DJHLDEKI JEFOD IEK EDO KI I D KDJ JE J D=DJ
E NHJEDI E C JH I D DGKJ HIFEDI JE DKIHEDEJEHI. 20042004
1.3.5.20 CH IEK JD MD KID= DJHLDEKI JEFOD KI E
DJHJEDI MJ EJH HK=I D FEJDJ JENJO J FJDJ I D ED
EH JEFOD. 20042004
1.3.5.21 EFOD LI IEK EDJEH MJD 24 EKHI E IJHJD= JHJDJ
D IKIGKDJO I HGKDJO I DJ O J D HKIJDI.
20042004
IFHIFHJEHO IJKDJIJEHO IJKDJI
1.3.5.22 J I HED JJ ENFH I KI EDO MD DED-DLIL LDJJED I
JH KDL EH EDIH DFFHEFHJ. 20042004
Chronic obstructive pulmonary disease (CG101)
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1.3.61.3.6 NO=D JHNO=D JHFFO KHD= O KHD= NHJEDI E CNHJEDI E C
NHJED IJED E JI =KD MI EKJI J IEF E J 2010 KFJ. $EMLH J
## MI MH JJ IE HEDJEDI D JI IJED E J =KD MH EKJ E J, D
JI L D HEL. HI IEK HH JE E FHEJEEI. J HEDJEDI D EKD D FFDN E J K =KD.
1.3.6.1 ENO=D IJKHJED IEK IKH D FJDJI MJ D NHJED E
C, JH H DE JI JE IKH HJH EE =II. 20042004
1.3.6.2 DIIHO, ENO=D IEK =LD JE F J 2 MJD J DLKI
JH=J HD=10
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1.3.6.3 KI ENJHI IEK L JE JH FHEIIEDI DLEL D
J H E FJDJI MJ NHJEDI E C D JO IEK JHD D
JH KI. CDDI IEK MH JJ FKI ENJHO =LI DE DEHJED
EKJ J C2 EH F$. 20042004
1.3.6.4 D J FJDJ HHLI J EIFJ, HJH EE =II IEK IKH
D J DIFH ENO=D EDDJHJED DEJ D FJDJI MJ D
NHJED E C. AHJH EE =I IKHDJI IEK HFJ
H=KHO, EHD= JE J HIFEDI JE JHJDJ. 20042004
1.3.71.3.7 ED-DED-DLILLIL L LDJJED () D C DJJED () D C NHJEDINHJEDI
1.3.7.1 IEK KI I J JHJDJ E E EH FHIIJDJ OFHFD
LDJJEHO KH KHD= NHJEDI IFJ EFJ JHFO. 20042004
1.3.7.2 J I HED JJ IEK LH D J IJJD= MJ IJ
ME L D JHD D JI FFJED, ME H NFHD D JI KI D MEH MH E JI JJEDI. 20042004
1.3.7.3 D FJDJI H IJHJ ED JH IEK H FD ELHD= MJ JE
E D J LDJ E JHEHJED D D=I E JHFO IEK =H. 20042004
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1.3.81.3.8 DDLILLIL L LDJJED D DJDILDJJED D DJDIL H H
1.3.8.1 JDJI MJ NHJEDI E C IEK HL JHJDJ ED DJDIL
H KDJI, DKD= DLIL LDJJED MD JI I JEK=J JE DIIHO.
20042004
1.3.8.2 KHD= NHJEDI E C, KDJED IJJKI, B, HGKHDJ EH ENO=D
MD IJ, EEHJI D FHLEKI IIEDI JE DJDIL H KDJI
IEK EDIH, D JED JE = D "!1, MD IIIID= IKJJO EH
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1.3.91.3.9 IFHIFHJEHO FJEHO FOIEJHOIEJHFFO D O D NHJEDINHJEDI
1.3.9.1 OIEJHFO KID= FEIJL NFHJEHO FHIIKH II IEK EDIH
EH IJ FJDJI MJ NHJEDI E C, JE F MJ HD= IFKJK.
20042004
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Chronic obstructive pulmonary disease (CG101)
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Chronic obstructive pulmonary disease (CG101)
© NICE 2010. All rights reserved. Page 44 of 61
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Chronic obstructive pulmonary disease (CG101)
© NICE 2010. All rights reserved. Page 45 of 61
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33 FDJJEDFDJJED
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Chronic obstructive pulmonary disease (CG101)
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4.3 Triple therapy
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Chronic obstructive pulmonary disease (CG101)
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55 JH LJH LHIEDI E JI =KDHIEDI E JI =KD
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Chronic obstructive pulmonary disease (CG101)
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66 J C! =KDJ C! =KD
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Chronic obstructive pulmonary disease (CG101)
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77 FJD= J =KDFJD= J =KD
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AFFDN A: #KD AFFDN A: #KD LLEFDJ #HEKFEFDJ #HEKF
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I JHD I JHD
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Deputies
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HEIIEH KDD #I (HEIIEH KDD #I (CH)CH)
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Chronic obstructive pulmonary disease (CG101)
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AFFDN B: #KD AFFDN B: #KD LM LM DD
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Chronic obstructive pulmonary disease (CG101)
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$D E $D ELLJEJE
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Chronic obstructive pulmonary disease (CG101)
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