Healthcare professionals should consider the risk of antimicrobial resistance when deciding whether antibiotics are needed for treating or preventing a flare up of symptoms of chronic obstructive pulmonary disease (COPD).

These draft recommendations come as NICE publishes draft antimicrobial prescribing guidance and a separate update to its 2010 clinical guideline on diagnosing and managing COPD.

The draft antimicrobial guidance recommends that antibiotics should be offered to people who have a severe flare up of symptoms, also known as a severe acute exacerbation.

Other factors should be considered before the use of antibiotics for treating an acute exacerbation that is not severe, such as the number and severity of symptoms.

Acute exacerbations of COPD can be caused by a range of factors including viral infections and smoking. Only around half are caused by bacterial infections, so many exacerbations will not respond to antibiotics.

COPD affects approximately three million people in the UK, two million of which are undiagnosed.