Smoking cessation can benefit most diseases and should be offered as a treatment. Studies in the UK and overseas have demonstrated that behavioural support, plus access to pharmacotherapy, is effective in helping smokers to quit. Evidence supports regular meetings – in a group or one to one – with a trained advisor using structured, withdrawal- oriented behavioural therapy combined with smoking cessation medicines such as NRT, bupropion or varenicline.

Inhaled therapies should be offered if the person needs them to reduce breathlessness and improve exercise tolerance. Note that any individual exhibiting asthmatic features should have an ICS in combination with a LABA. Asthmatic features are defined in NICE guideline NG115 as including “any previous, secure diagnosis of asthma or of atopy, a higher blood eosinophil count, substantial variation in FEV1 over time (at least 400ml) or substantial diurnal variation in peak expiratory flow (at least 20 per cent)”.

Vaccination, including the pneumococcal and annual flu vaccination, should be offered to people with COPD to minimise the incidence of respiratory infections.

Mucolytic drug trial (anecdotally four to six weeks) could be considered for people with a chronic productive cough. It should be stopped if it is not beneficial and should be used with caution in people with a history of peptic ulceration.

Oral theophyllines may be beneficial in people who remain breathless, despite trialling inhaled therapy, or for those who cannot use inhaled therapy – noting the potential for interactions and requirement for plasma monitoring.

Roflumilast (phosphodiesterase IV inhibitor) can be used as adjunctive therapy in people with severe COPD associated with chronic bronchitis and frequent exacerbations, in line with the 2017 NICE technology appraisal guidance TA461.