A consensus-based article that sets out a simple treatment pathway based on the predominant characteristics
Sixteen years ago I was diagnosed with COPD. My COPD means I get breathless very quickly now doing activities or things I previously did easily without and difficulty. Being as active as possible really helps me to manage my condition, so I have joined a gym for the first time as they have sessions purely for people with lung problems. Attending these sessions weekly has resulted in me being able to control the periods of breathlessness.
Bronchoscopic and surgical treatments for people with COPD can improve their lung and exercise capacity, and quality and length of life for many years in addition to what medical treatments can achieve. This pragmatic guide has been developed to highlight to people working in primary care what bronchoscopic and surgical options are currently available, what is in the experimental pipeline, who might be suitable and how primary care can work with specialists to help patients make the right choice for them, prepare for surgery, and provide support afterwards.
PCRS advocate a pragmatic approach to the pharmacological management of patients with COPD guided by the predominance of breathlessness and/or exacerbations and the presence or absence of comorbid asthma. Clinicians must undertake a holistic evaluation for alternative causes of persistent daily symptoms or repeated exacerbations and consider seeking advice from a respiratory specialist before escalating to triple therapy (a respiratory specialist may be a GP/nurse/consultant).
In this article the authors review current evidence and guidance for the treatment of Chronic obstructive pulmonary disease (COPD) in order to bring up to date the Primary Care Respiratory Society (PCRS) consensus approach and algorithm first published in 2017 known as ‘Keeping it Simple’.
Spirometry is a component of the diagnosis and management of respiratory conditions in primary care and should ideally be performed via referral to a primary care network respiratory diagnostic service or community diagnostics centre (CDC) with expertise in the diagnosis of the most common respiratory conditions and of less common diagnoses. Where limited resources create a challenge for testing everyone with a new suspected diagnosis of asthma, those with an intermediate probability should be prioritised for spirometry and also FENO where available.
This update from PCRU guest editor and PCRS Executive Chair, Katherine Hickman, gives an overview of the latest edition of the update. Katherine says: "I hope this edition inspires confidence in managing COPD, addressing COVID-19 concerns, and ultimately reflecting on the loss of Dr Iain Small who really was one in a million. I hope you are able to take some time off over the Christmas break, recharge, and come back in the New Year invigorated and impassioned to continue our mission of supporting those with respiratory disease."
Date for review: 23rd October 2025