Incorporation of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of severity of expiratory airflow limitation in chronic obstructive pulmonary disease (COPD) into the recent National Institute for Health and Clinical Excellence (NICE) guidelines is welcome and sensible.1 Describing a forced expiratory volume in one second (FEV₁) of 51% predicted as ‘mild disease’ fails to capture the loss of lung function and irreversible damage done. Recognition and optimal early management of COPD cannot be overemphasised to limit its long-term health consequences.

However, we have concerns that its adoption without adequate explanation in the UK could have unintended negative consequences in this patient group if presenting acutely unwell, when decisions regarding intensive care and use of invasive mechanical ventilation (IMV) are being made.

Widely varying ICU admission criteria and prognostic pessimism among UK critical care physicians regarding COPD have been demonstrated.2 3...

Authors : Collins, A., Walden, A., Parker, R.
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