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PCRS consensus article addresses conflicting COPD guidelines


A consensus-based article setting out a practical approach to conflicting advice in recent COPD guidance updates has been published by PCRS.

It focuses on the similarities and differences of recommendations on pharmacotherapy in the most recent 2019 GOLD revision, published in November 2018, and the updated NICE guideline published in December 2018.  There is very little controversy in any of the other sections of the two guidelines. 

All that glitters is not GOLD, nor is it even NICE examines the advice given by GOLD and NICE on treatment algorithms and the role of eosinophils in determining the use of ICS in COPD. It then sets out a simple treatment pathway based on the predominant characteristics of COPD for an individual – whether symptoms or exacerbations – distilled from the guidance.

The article has been developed by a group of clinicians working with and in primary care, facilitated by integrated care consultant Vince Mak; GPs Duncan Keeley, Noel Baxter and Kevin Gruffydd Jones; practice nurse Carol Stonham; and pharmacist Anna Murphy.

“Major differences in the advice on how to manage COPD from reputable guideline providers are a problem for primary care. They reflect limitations in the available evidence and difficulties in its interpretation. This article has outlined what we, as a group of professionals experienced in the management of COPD, consider to be a practical way forward in reconciling this conflicting advice and one that is consistent with the evidence base,” say the authors.

Dr Noel Baxter, PCRS Executive Chair, says: “PCRS knows that its members and wider audience want pragmatic and evidence informed guidance to help them deal with the day to day in asthma and COPD. The multidisciplinary and clinically experienced authors who have updated our position on pharmaceutical management of COPD using the best of both GOLD and NICE and considering new evidence will be a helpful tool for clinicians wanting practical answers.”