New COPD Guidelines

Updated Guidelines for the Diagnosis and Management of COPD

 

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The American College of Physicians (ACP) has developed new guidelines for the diagnosis and management of stable chronic obstructive pulmonary disease (COPD), intended for all clinicians who manage patients with COPD.  These recommendations were developed in collaboration with the American College of Chest Physicians, American Thoracic Society, and European Respiratory Society and are updated from those last published in 2007.  The guidelines differ only slightly from the last published version and are meant to focus on the critical need to manage the disease and reduce hospitalizations, exacerbations, and deaths.

There are seven basic guidelines:

  1. Clinicians should use spirometry to diagnose COPD only in symptomatic patients; spirometry should not be used to screen for airflow obstruction in patients without respiratory symptoms.
  2. For stable, symptomatic patients with an FEV1 between 60% and 80% predicted, consider treatment with inhaled bronchodilators. This is an update of the 2007 guidelines.
  3. For stable, symptomatic patients with an FEV1 <60% predicted, recommend treatment with inhaled bronchodilators.
  4. For symptomatic patients with an FEV1 <60% predicted, recommend monotherapy with either long-acting inhaled anticholinergics or long-acting inhaled β-agonists.  Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile (this part of the recommendation is new).
  5. For stable, symptomatic patients with FEV1 <60% predicted, consider combination inhaled therapies (anticholinergics, β-agonists, or corticosteroids).  However, there is not enough evidence to recommend when combination therapy should be chosen over monotherapy.
  6. For symptomatic patients with an FEV1 <50% predicted, pulmonary rehabilitation should be considered. This is a new recommendation.
  7. For symptomatic patients with severe resting hypoxemia, continuous oxygen therapy should be prescribed. This is a new recommendation.

One message has not changed since the last update: the importance of smoking cessation. Cigarette smoking is the leading risk factor for COPD and causes irreversible lung damage.  COPD is currently the third leading cause of death in the United States; in 2007, it was the fifth leading cause of death.

Published on August 9, 2011

Source: Qaseem A, Wilt TJ, Weinberger SE, et al. Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society. Ann Intern Med. 2011;155:179-191.