New Guidelines Issued for COPD Diagnosis, Management

A joint guideline recommends spirometry, inhaled therapies, rehabilitation, and oxygen for COPD

TUESDAY, Aug. 2 (HealthDay News) -- Clinicians should use spirometry for screening or diagnosis, and inhaled therapies, pulmonary rehabilitation programs, and supplemental oxygen therapy to improve management of chronic obstructive pulmonary disorder (COPD), according to the joint practice guidelines of the American College of Physicians (ACP), the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society, published in the Aug. 2 issue of the Annals of Internal Medicine.

Amir Qaseem, M.D., Ph.D., M.H.A., from the ACP and Temple University in Philadelphia, and colleagues reviewed available literature from 2007 to 2009 to evaluate the evidence for diagnosing and managing stable COPD, and to update the 2007 ACP clinical practice guidelines.

The researchers recommend spirometry to diagnose airflow obstruction in patients with respiratory symptoms, but not to screen airflow obstruction in patients without respiratory symptoms. Patients with respiratory symptoms and predicted forced expiratory volume in one second (FEV1) of either less than 60 percent or between 60 to 80 percent can be treated with inhaled bronchodilators. Stable, symptomatic patients with predicted FEV1 of less then 60 percent should be treated with inhaled bronchodilators. Symptomatic patients with COPD and FEV1 of less than 60 percent are recommended to use long-acting inhaled monotherapy of anticholinergics or β-agonists. Combination inhaled therapy is suggested for symptomatic patients with stable COPD and predicted FEV1 of less than 60 percent. Pulmonary rehabilitation is recommended for symptomatic patients with predicted FEV1 of less than 50 percent and should be considered for symptomatic or exercise-limited patients with predicted FEV1 of greater than 50 percent. Continuous oxygen therapy is recommended in patients 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," the authors write.

Several of the study authors disclosed financial ties to the pharmaceutical industry.

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