PCRS calls on NICE to review point of care CRP testing

PCRS is highlighting the need for NICE to review the introduction of point of care test C-reactive protein (CRP) - guided assessments for people presenting with COPD crises, following the emergence of new evidence.

This data from the PACE study, published in July last year, shows that such testing in primary care can reduce unnecessary prescribing of antibiotics without compromising patient safety.

PCRS is now calling on NICE to review the December 2018 COPD antimicrobial prescribing guidelines, to enable clinicians and system leaders to understand whether and how to implement this diagnostic aid.

The PACE study was a multicentre trial conducted in 86 primary care clinics in England and Wales.  Some 653 patients with an acute exacerbation of COPD were randomised to receive usual care guided by point-of-care CRP testing via a rapid finger prick test or usual care only.

Antibiotic prescribing was 20% lower among those patients who received usual care guided by point-of-care CRP testing compared with those who received usual care only. Importantly, this reduction in antibiotic use did not have a negative effect on patients’ recovery over the first two weeks after their consultation at their GP surgery or on their well-being or use of health care services over the following six months.

In a new position statement PCRS recommends:

• Patients presenting with acutely worsening symptoms and known to have COPD should receive antibiotics only when the COPD exacerbation has been determined as the cause of the change and when bacterial infection is considered to be the most likely trigger.
• CRP point-of-care testing in primary care may help reduce unnecessary prescribing of antibiotics for people with COPD by enabling a more considered diagnostic approach to people with COPD in crisis.
• When evaluating a patient with COPD experiencing a symptomatic exacerbation, such as cough and worsening breathlessness, all potential triggers should be considered including tobacco exposure, air quality, psychosocial factors, viral infection, and bacterial infection.

Noel Baxter, PCRS Policy Lead, says: “People with COPD who present in crisis have for too long received a one size fits all response of ‘antibiotics plus steroids’ which is too simplistic and often wrong. As we acquire the evidence that gives us a better understanding of the cause of crisis and the option to provide better value treatment we need to ensure that robust cost effectiveness analysis and guidance follows suit.”