Spirometry testing for patients who are incidentally found to have signs of COPD on a chest X-ray or CT scan at hospital should be performed in primary care, NICE has said.
The new draft NICE guideline for COPD, the first to be published since 2010, says hospitals should refer these patients back to their GP surgeries for further testing.
NICE said the new recommendation should have only ‘minimal impact’ on general practice resources.
The guideline also updates COPD treatment recommendations, including:
- LAMA and LABA combination therapy for patients with spirometrically confirmed COPD without asthmatic features who continue to experience breathlessness and;
- A LABA with inhaled corticosteroid for patients who do have asthmatic features.
It goes on to highlight the need for sputum culture before prescribing prophylactic antibiotics and to keep weighing up the benefits and risks, reminding that there are no long-term studies on the use of prophylactic antibiotics in COPD patients.
Dr Mark Levy, locum GPSI in respiratory medicine in London, said that it was ‘reasonable’ for primary care to review patients with incidental findings but added that ‘the degree of resource impact will depend on the facilities and expertise at the practice.
‘If there is no spirometry, patients will have to be referred for this,’ he said.