Current initiatives in the management of patients with chronic obstructive pulmonary disease: The NICE guidelines and the recent evidence base

Abstract

Hospital at home schemes are an alternative strategy to reduce length of hospital stay, and are safe and acceptable to patients and carers in selected patients referred to hospital with acute exacerbations of COPD. Current pulmonary rehabilitation provision in the UK is inadequate and provision of the service for those who are aged 70 years and above is limited. Tiotropium is a promising drug for patients with COPD, improving quality of life and reducing dyspnoea and frequency of exacerbations. Its efficacy in older patients is worthy of investigation. Early NIPPV intervention in those patients admitted with acute exacerbations and with respiratory failure improves quality of life and reduces inpatient hospital mortality. © British Geriatrics Society 2004; all rights reserved.