The COPD work stream of the Respiratory Health Implementation Group (RHIG) completed the development of this guideline 2019 following the publication of the PACE study in the New England Journal of Medicine. This guideline has been developed following consultation with the National Antimicrobial Group and the National Point of Care Group, and with support from the authors of the PACE study.

The All-Wales Acute Exacerbation of COPD Pathway is the first national guideline to include C-Reactive Protein (CRP) point of care testing to guide antibiotic prescribing. The aim of this guideline is to reduce overall antibiotic prescribing for patients presenting to primary care with a COPD exacerbation.

Key recommendations:

• Identify those patients without increased sputum purulence, and proceed with non-antibiotic management
• Identify those patients with increased sputum purulence, and proceed to perform a point-of-care CRP test
• Categorise a patient according to a CRP test, to guide antibiotic prescribing