Four organizations released clinical practice guidelines on the diagnosis and the treatment of chronic pulmonary obstructive disease (COPD). The four organizations include The American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS). ACP convened the four organizations, which represent more than 170,000 physicians from around the world, to develop the joint guideline.
"This clinical practice guideline aims to help clinicians to diagnose and manage stable COPD, prevent and treat exacerbations, reduce hospitalizations and deaths, and improve the quality of life of patients with COPD," said lead author Amir Qaseem, MD, FACP, PhD, Director of Clinical Policy, American College of Physicians. "It is important for patients with COPD to stop smoking and for physicians to help their patients to quit smoking."
COPD occurs predominantly in cigarette smokers. COPD symptoms include chronic cough, wheezing, shortness of breath, or significant activity limitation.
The clinical practice guideline includes the following recommendations:
- ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms.
"While targeted use of spirometry for diagnosis of airflow obstruction is beneficial for patients with respiratory symptoms, particularly dyspnea, it does not appear to have an independent influence on the likelihood of quitting smoking or maintaining abstinence," noted Nicola A. Hanania, MD, MS, FCCP, Chair, Airways Disorders NetWork, American College of Chest Physicians.
- ACP, ACCP, ATS, and ERS recommend that spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms.
"The routine use of spirometry for patients without respiratory symptoms could lead to unnecessary testing, increased costs, unnecessary disease labeling, and the harms of long-term treatment with no known preventive effect on avoiding future symptoms," said Gerard Criner, MD, Professor of Medicine, Temple University, and past chair of the American Thoracic Society's Assembly on Clinical Problems.
- For stable COPD patients with respiratory symptoms and FEV1 (forced expiratory volume in 1 second) between 60 percent and 80 percent predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used. (FEV1 is measured by spirometry, a breathing test that measures how much air a person can blow out in one second.)
- For stable COPD patients with respiratory symptoms and FEV1 less than 60 percent predicted, ACP, ACCP, ATS, and ERS recommend treatment with inhaled bronchodilators.
- ACP, ACCP, ATS, and ERS recommend that clinicians prescribe monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled beta agonists for symptomatic patients with COPD and FEV1 less than 60 percent predicted. Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile.
- ACP, ACCP, ATS, and ERS suggest that clinicians may administer combination inhaled therapies (long acting inhaled anticholinergics, long-acting inhaled beta agonists, or inhaled corticosteroids) for symptomatic patients with stable COPD and FEV1 less than 60 percent predicted.
- ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV1 less than 50 percent predicted. Clinicians may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV1 greater than 50 percent predicted.
- ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia.