← GPCalc

NICE COPD Calculator

NICE NG115 Chronic obstructive pulmonary disease in over 16s · NG114 exacerbation antibiotics · inhalers from the Cheshire & Merseyside formulary

Patient

Spirometry & symptoms

Exacerbations (last 12 months)

Current treatment

NICE-recommended plan

Enter age and spirometry (or tick 'not yet done') to see the plan.

Decision support only, based on NICE NG115, NG114 and linked technology appraisals. Inhaler choices follow the Cheshire & Merseyside APG formulary (checked October 2026). It does not replace clinical judgement, the full guideline or the SPC. Severe or acute breathlessness needs urgent assessment.

Quick reference

Diagnosis & severity

Suspect COPD over 35 with a smoking history and exertional breathlessness, chronic cough, sputum, winter "bronchitis" or wheeze (1.1.1). Confirm with post-bronchodilator spirometry: FEV1/FVC <0.7 (1.1.5).

StageFEV1 % predicted
1 Mild≥80% (diagnose only with symptoms)
2 Moderate50–79%
3 Severe30–49%
4 Very severe<30% (or <50% with respiratory failure)

NG115 table 4. At diagnosis: CXR, FBC, BMI (1.1.15). Alpha-1 antitrypsin if early onset, little smoking or family history.

Inhaled therapy steps
  1. Short-acting bronchodilator as needed (1.2.6)
  2. Still breathless or exacerbating (non-drug care optimised): LAMA + LABA; if asthmatic features, consider LABA + ICS (1.2.10, 1.2.11)
  3. LABA + ICS → triple if symptoms affect quality of life, a severe exacerbation, or 2 moderate exacerbations a year (1.2.14)
  4. LAMA + LABA → consider triple after a severe or 2 moderate exacerbations (1.2.15); for symptoms alone, a 3-month trial only (1.2.16)
  5. Review ICS yearly and document why it continues (1.2.17)
Oxygen, rehab, self-management
  • Assess for oxygen if FEV1 <30%, cyanosis, polycythaemia, oedema, raised JVP or SpO2 ≤92% (1.2.57). LTOT if PaO2 <7.3 kPa, or 7.3–8 kPa with polycythaemia, oedema or pulmonary hypertension; non-smokers only; ≥15 hours a day (1.2.59–1.2.63).
  • Pulmonary rehab for anyone functionally disabled (usually MRC ≥3), including after admission (1.2.82, 1.2.83).
  • Rescue pack if an exacerbation in the last year: prednisolone 30 mg for 5 days plus an antibiotic (1.2.128, 1.3.16; NG114).
  • Azithromycin prophylaxis: non-smokers, optimised, with frequent (≥4/yr), prolonged or hospitalised exacerbations; ECG, LFTs, sputum culture and CT first (1.2.45–1.2.47).
  • Review yearly; twice yearly if very severe (1.2.140, 1.2.142).