The 2010 NICE COPD Guidelines: how do they compare with the GOLD guidelines?

The UK National Institute for Health and Clinical Excellence (NICE) has produced a 2010 partial update of its original 2004 Guidelines on COPD management. The definition of airflow obstruction has been altered to a post-bronchodilator FEV1/FVC ratio < 0.7 and the severity of airflow obstruction has been similarly aligned with the Global initiative for Obstructive Lung Disease (GOLD) guideline definition. However, patients with GOLD Stage 1 (i.e. FEV1 predicted ≥ 80%) must be symptomatic for a diagnosis of COPD to be made under the new NICE criteria. Recent large scale trials have resulted in a new inhaled pharmacotherapy algorithm which includes early use of inhaled corticosteroid/long-acting β2-agonist combination therapy for patients with an FEV1 < 50% predicted. In spite of an apparent emphasis on pharmacotherapy, both GOLD and NICE Guidelines emphasise that COPD is a multi-system disease requiring a multidimensional approach to treatment. In particular, the importance of smoking cessation and pulmonary rehabilitation is reiterated, the latter not only being of use in managing stable disease but also following hospital discharge.