Denominator – the number of planning applications for major developments granted permission. Denominator – the number of people who smoke who have set a quit date with an evidence-based smoking cessation service. 1.1.4 If an antibiotic is given, give advice: about possible adverse effects of the antibiotic, particularly diarrhoea, that symptoms may not be fully resolved when the antibiotic course has been completed, symptoms worsen rapidly or significantly or, symptoms do not start to improve within 2–3 days (or other agreed time) or. Warnings include: stopping treatment at first signs of a serious adverse reaction (such as tendonitis), prescribing with special caution in people over 60 years and avoiding coadministration with a corticosteroid (March 2019). This can be individual or group behavioural support. British Medical Journal 2: 257–66. c) Proportion of attendances of people with stable COPD and exercise limitation due to breathlessness that result in the person completing a pulmonary rehabilitation programme. PCRS and other organisations advised that this omission would render the guideline out of date on The recommendations on assessment of a person with an acute exacerbation of COPD are largely based on the NICE clinical guidelines Chronic obstructive pulmonary disease (acute exacerbation): antimicrobial prescribing [NICE, 2018a] and Chronic obstructive pulmonary disease in over 16s: diagnosis and management [NICE, 2019a], the clinical guidelines COPD-X: concise guide for primary care [Lung … Numerator – the number of people in the denominator who receive advice on how to stop. 2. Elderly people, or people with learning disabilities, physical disabilities or cognitive impairment may experience difficulties learning and retaining the adequate inhaler technique to ensure that they get the optimal treatment dose. (1959) The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. b) Proportion of people who smoke who receive advice on how to stop. a) Proportion of people with stable COPD and exercise limitation due to breathlessness who are referred to a pulmonary rehabilitation programme. NICE Bites is a monthly prescribing bulletin published by North West Medicines Information centre which summarises key recommendations from NICE guidance. People have the right to be involved in discussions and make informed decisions about their care, as described in. Proportion of people who seek support to stop smoking and who agree to take pharmacotherapy who receive a full course. 8 Table 3 highlights the factors … Numerator – the number in the denominator whose oxygen saturation levels are maintained between 88% and 92%. © NICE 2021. Numerator – the number in the denominator with conditions or obligations to minimise and mitigate road-traffic-related air pollution. Local authorities should ensure that they assess the impact on vulnerable groups if local charges on certain classes of vehicle in clean air zones are proposed. Not troubled by breathlessness except on strenuous exercise. Medical Research Council dyspnoea scale of breathlessness grade 3 and above. Hospital discharge care bundles are designed to ensure that every person leaving hospital receives the best care. Health effects may occur when air pollution is moderate (4 to 6), high (7 to 9) or very high (10). In the context of primary care settings, this would involve evidence-based, opportunistic advice offered to people who smoke about the options and support available to help them stop smoking. Numerator – the number in the denominator that result in the person completing a pulmonary rehabilitation programme. However, the National Institute of Clinical Excellence (NICE) 2018 guidelines recommend against its use in primary care because it is time-intensive and challenging to carry out. Denominator – the number of people with COPD prescribed an inhaler. a) Evidence that local authorities identify in the Local Plan, local transport plan and other key strategies how they will address air pollution, including who is responsible for delivering key actions. 1.1.5 If no antibiotic is given, give advice about: symptoms (such as sputum colour changes and increases in volume or thickness) worsen rapidly or significantly or, symptoms do not start to improve within an agreed time or. a) Proportion of zero- or ultra-low-emission vehicles in public sector vehicle fleets. People with COPD and a persistent resting stable oxygen saturation of 92% or less should be assessed for their suitability for LTOT, which can improve survival, pulmonary haemodynamics, polycythaemia and neuropsychological health. Clinical practice. These quality statements are taken from the. To assess cardiac status if cardiac disease or pulmonary hypertension are suspected because of: To assess cardiac status if cardiac disease or pulmonary hypertension are suspected, To investigate symptoms that seem disproportionate to the spirometric impairment, To investigate signs that may suggest another lung diagnosis (such as fibrosis or bronchiectasis, To investigate abnormalities seen on a chest X-ray, To assess suitability for lung volume reduction procedures, To assess for alpha-1 antitrypsin deficiency if early onset, minimal smoking history or family history, Night-time waking with breathlessness and/or wheeze, Significant diurnal to day-to-day variability of symptoms, The person with COPD requests a second opinion, Assessment for long-term nebuliser therapy, Optimise therapy and exclude inappropriate prescriptions, Assessment for oral corticosteroid therapy, Justify need for continued treatment or supervise withdrawal, Identify candidates for lung volume reduction procedures, Identify candidates for pulmonary rehabilitation, Assessment for lung volume reduction procedures, Identify candidates for surgical or bronchoscopic lung volume reduction, Confirm diagnosis, optimise pharmacotherapy and access other therapists, Onset of symptoms under 40 years or a family history of alpha-1 antitrypsin deficiency, Identify alpha-1 antitrypsin deficiency, consider therapy and screen family, Symptoms disproportionate to lung function deficit, Look for other explanations including cardiac impairment, pulmonary hypertension, depression and hyperventilation, Factors to consider when deciding where to treat the person, Significant comorbidity (particularly cardiac disease and insulin-dependent diabetes), 200 mg on first day, then 100 mg once a day for 5-day course in total (see, Use alternative first choice (from a different class), Levofloxacin (with specialist advice if co-amoxiclav or co-trimoxazole cannot be used; consider safety issues, Consult local microbiologist; guided by susceptibilities, A general classification of the severity of an acute exacerbation (provided in. 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