New guidelines for COPD diagnosis, management

The American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ACT), and the European Respiratory Society (ERS) have issued updated recommendations to the 2007 ACP clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD). The new recommendations were published in Annals of Internal Medicine.

The updated guidelines, which are based on a targeted literature update from March 2007 to December 2009, are intended for clinicians who manage patients with COPD. The update addresses the value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies (anticholinergics, long-acting beta-agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy.

The updated clinical practice guidelines include the following recommendations:

1. ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms.
ACP, ACCP, ATS, and ERS recommend that spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms.
2. For stable COPD patients with respiratory symptoms and FEV1 (forced expiratory volume in 1 second) between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used.
3. For stable COPD patients with respiratory symptoms and FEV1 less than 60% predicted, ACP, ACCP, ATS, and ERS recommend treatment with inhaled bronchodilators.
4. 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% predicted. Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile.
5. 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% predicted.
6. ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV1 less than 50% predicted. Clinicians may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV1 greater than 50% predicted.
7. ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia.

“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, ACIP, in a press release. “It is important for patients with COPD to stop smoking and for physicians to help their patients to quit smoking.”