Point-of-care testing of C-reactive protein (CRP) for the acute assessment of worsening symptoms in people known to have COPD can safely reduce the use of antibiotics and could help improve the diagnostic approach towards someone presenting in such a crisis. New high-quality evidence has emerged since the last NICE COPD update and we encourage re-opening and review of the current guideline to enable clinicians and system leaders to understand whether and how to implement this promising diagnostic aid.

PCRS advocates that:

• Patients with acutely worsening symptoms and known diagnosis of COPD should receive antibiotics only when there is confirmed evidence of a COPD exacerbation and/or a bacterial infection. (They may also require steroids in line with global guidance).
• Sputum purulence is as accurate at predicting the presence of bacterial pathogens as point-of-care C-reactive protein (CRP) protein in exacerbations of COPD.
• Using of point-of-care-testing such as CRP testing would be a valuable addition to support treatment decisions if resources were available.
• When evaluating a patient with COPD experiencing a symptomatic exacerbation such as cough and worsening breathlessness, all potential triggers should be considered including tobacco exposure, air quality, psychosocial factors, viral infection and bacterial infection to avoid unnecessary prescribing of antibiotics.