NICE guidance - treatments for COPD (chronic obstructive pulmonary disease) - OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

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Lifestyle advice for COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

explain to people with mild COPD-OSAHS who have no symptoms or with symptoms that do not affect usual daytime activities that:

  • treatment is not usually needed and
  • changes to lifestyle and sleep habits can help to prevent COPD-OSAHS from worsening
    • lifestyle advice for all severities of COPD-OSAHS
      • discuss appropriate lifestyle changes with all people with COPD-OSAHS. Provide support and information on losing weight, stopping smoking, reducing alcohol intake and improving sleep hygiene, tailored to the person's needs and in line with the NICE guidelines on:
        • stop smoking interventions and services
        • preventing excess weight gain
        • obesity: identification, assessment and management (in particular, the section on lifestyle interventions)
        • alcohol-use disorders: prevention (in particular, recommendations on screening, brief advice and extended brief interventions for adults)

Treatments for COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

CPAP and non-invasive ventilation

  • consider continuous positive airway pressure (CPAP) as first-line treatment for people with COPD-OSAHS overlap syndrome if they do not have severe hypercapnia (PaCO2 of 7.0 kPa or less)
  • consider non-invasive ventilation instead of CPAP for people with COPD–OSAHS overlap syndrome with nocturnal hypoventilation if they have severe hypercapnia (PaCO2 greater than 7.0 kPa)
  • consider heated humidification in addition to CPAP for people with COPD–OSAHS overlap syndrome and upper airway side effects such as nasal and mouth dryness, and CPAP-induced rhinitis

Oxygen therapy

  • consider supplemental oxygen for people with COPD-OSAHS overlap syndrome if hypoxaemia persists once control of apnoea and nocturnal hypoventilation has been optimised by CPAP or non-invasive ventilation, and address any additional underlying causes of hypoxaemia where possible

Managing rhinitis in people with COPD (chronic obstructive pulmonary disease)-OSAHS (obstructive sleep apnoea/hypopnoea syndrome) overlap syndrome

  • assess people with nasal congestion and COPD-OSAHS for underlying allergic or vasomotor rhinitis
  • if rhinitis is diagnosed in people with COPD-OSAHS, offer initial treatment with:
    • topical nasal corticosteroids or antihistamines for allergic rhinitis or
    • topical nasal corticosteroids for vasomotor rhinitis
  • for people with COPD-OSAHS and persistent rhinitis, consider referral to an ear, nose and throat specialist if:
    • symptoms do not improve with initial treatment or
    • anatomical obstruction is suspected
  • be aware that:
    • rhinitis can affect people's tolerance to continuous positive airway pressure (CPAP) but changing from a nasal to an orofacial mask and adding humidification can help
    • CPAP can worsen or cause rhinitis and nasal congestion

Reference:

Last edited 09/2021 and last reviewed 10/2021

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