Quality Standards
Issued: July 2011

Chronic obstructive pulmonary disease quality standard

Introduction and overview

Chronic obstructive pulmonary disease (COPD) is an overarching term used to describe a number of conditions including chronic bronchitis, emphysema, chronic obstructive airways disease and chronic airflow limitation. COPD is a chronic disorder characterised by consistent airflow obstruction and is associated with persistent and progressive breathlessness, a chronic productive cough and limited exercise capacity. The airflow obstruction is usually progressive, not fully reversible and does not change markedly over several months. About 900,000 people have diagnosed COPD. Prevalence increases with age (it is rare before 35 years of age) and is mostly associated with smoking. COPD remains the fifth most common cause of death in England and Wales, accounting for more than 28,000 deaths in 2005 and is the second largest cause of emergency admission in the UK, with one in eight (13,000) emergency admissions to hospital as a result of COPD. One fifth (21%) of bed days used for respiratory disease treatment are due to chronic obstructive lung disease, such that COPD accounts for more than one million 'bed days' each year in hospitals in the UK.

This quality standard covers the assessment, diagnosis and clinical management of chronic obstructive pulmonary disease (COPD) in adults. The scope of the quality standard does not include prevention, screening or case finding.


This quality standard describes markers of high-quality, cost-effective care that, when delivered collectively, should contribute to improving the effectiveness, safety and experience of care for people with COPD in the following ways:

  • Preventing people from dying prematurely.

  • Enhancing quality of life for people with long-term conditions.

  • Helping people to recover from episodes of ill health, or following injury.

  • Ensuring that people have a positive experience of care.

  • Treating and caring for people in a safe environment and protecting them from avoidable harm.

The NHS Outcomes Framework 2011/12 is available from www.gov.uk.

The quality standard is also expected to contribute to the following overarching indicators from the 2011/12 Adult Social Care Framework:

  • Enhancing quality of life for people with care and support needs.

  • Ensuring that people have a positive experience of care and support.

  • Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm.

This quality standard for COPD should be considered together with An Outcomes Strategy for COPD and Asthma in England and associated guidance. The quality standard and the Outcomes Strategy are complementary but serve different purposes.

The quality standard provides a set of clear statements describing high-quality care within the scope outlined above. It focuses on assessment, diagnosis and the treatment of diagnosed COPD. It is based on current NICE guidance and is consistent with the Outcomes Strategy for the areas it covers.

The Outcomes Strategy has a broader scope that also includes prevention, case finding, early detection and organisation of care. It sets out a vision for future services that is likely to require a significant change in emphasis for public health and NHS services. It is intended to improve the quality of care for people with suspected COPD as well as those with a confirmed diagnosis. As part of this focus, it recommends piloting certain interventions and strategies to determine the best ways of delivering different models of care.

Both this quality standard and the Outcomes Strategy, and commissioning guidance associated with them, should be used by commissioners to make improvements in the full range of COPD services.


The quality standard for chronic obstructive pulmonary disease (COPD) requires that services should be commissioned from and coordinated across all relevant agencies encompassing the whole COPD care pathway. An integrated approach to provision of services is fundamental to the delivery of high-quality care to people with COPD. This should be considered together with An Outcomes Strategy for COPD and Asthma in England and associated guidance. The quality standard and the Outcomes Strategy are complementary but serve different purposes.

NICE quality standards are for use by the NHS in England and do not have formal status in the social care sector. However, the NHS will not be able to provide a comprehensive service for all without working with social care communities. In this quality standard care has been taken to make sure that any quality statements that refer to the social care sector are relevant and evidence-based. Social care commissioners and providers may therefore wish to use them, both to improve the quality of their services and support their colleagues in the NHS.

Subject to legislation currently before Parliament, NICE will be given a brief to produce quality standards for social care. These standards will link with corresponding topics published for the NHS. They will be developed in full consultation with the social care sector and will be presented and disseminated in ways that meet the needs of the social care community. As we develop this library of social care standards, we will review and adapt any published NICE quality standards for the NHS that make reference to social care.