The updated NICE guideline now specifies that post-bronchodilator spirometry should be used for diagnosis of COPD, reflecting the recommendations made by other guidelines and the QOF.

Somerset GP and General Practice Airways Group member Dr Steve Holmes welcomed this alteration. ‘It is something that we wanted put in the last time around,' he said. ‘It should help reduce the number of patients with reversible airway disease who are being misdiagnosed with COPD.'

NICE has also updated its recommendations on the treatment of COPD.

Patients who suffer breathlessness or exacerbations, despite treatment with a short-acting beta-2 agonist and who have an FEV1 of 50 per cent or more, should now be offered treatment with either a long-acting muscarinic antagonist (LAMA) or a long-acting beta-2 agonist (LABA).

Those with an FEV1 below 50 per cent should be offered either a LABA with an inhaled corticosteroid (ICS) in a combination inhaler, or a LAMA.

Those patients who remain breathless or experience exacerbations, despite taking a LABA plus ICS, should now be offered a LAMA no matter what their FEV1.

The updated draft guideline is open for consultation until 5 January 2010.