The American College of Physicians (ACP) has released a new clinical practice guideline on diagnosing and treating stable chronic obstructive pulmonary disease (COPD), a slowly progressive lung disease involving the airways and lung tissue, resulting in a gradual loss of lung function, typically as a result of smoking.
COPD affects more than 5 percent of the adult population in the United States and is the fourth leading cause of death and twelfth leading cause of illness. The symptoms of COPD range from chronic cough and wheezing to more severe symptoms such as shortness of breath and significant activity limitation.
The term COPD includes both emphysema and chronic bronchitis. Physicians often use the broader term COPD, since affected patients frequently have components of both processes.
The guideline offers six recommendations, including:
· In patients with respiratory symptoms, particularly shortness of breath, spirometry (a simple test in which a person blows into a machine that measures the amount of gas breathed into it over a period of time) should be performed to diagnose airflow obstruction. Spirometry should not be used to screen for airflow obstruction in asymptomatic individuals.
· Treatment of stable COPD should be reserved for patients who have respiratory symptoms and forced expiratory volume in one second (FEV1) less than 60 percent predicted, as documented by spirometry.
· For symptomatic patients with COPD and FEV1 less than 60 percent predicted, clinicians should prescribe long-acting inhaled â-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids.
· Clinicians should prescribe oxygen therapy in patients with COPD and insufficient levels of oxygen in the circulating blood while resting.
"The evidence does not support using spirometry as a diagnostic strategy for individuals not reporting respiratory symptoms," said Steven Weinberger, MD, FACP, Senior Vice President, Medical Education and Publishing at ACP, and an author of the guideline. "However, adding spirometry to clinical examinations for individuals with respiratory symptoms, especially shortness of breath, has demonstrated benefits."
The guideline, published in the Nov. 6, 2007, issue of Annals of Internal Medicine, is based on a systematic evidence review of published studies by Timothy J. Wilt, MD, MPH, and the Agency for Healthcare Research and Quality-sponsored Minnesota Evidence-based Practice Center evidence report.
"It is important that all individuals with COPD stop smoking to prevent progression of the disease," Dr. Weinberger said. "Of course, even smokers without COPD should stop smoking to decrease the risk of both COPD and lung cancer. It's never too late to stop."
The target audience for the guideline is all physicians and the target patient population is all adults with COPD.