Guidelines For Diagnosis And Treatment Of Stable COPD Issued By The ACP, Accompanying Video Included

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Main Category: COPD
Also Included In: Primary Care / General Practice;  Smoking / Quit Smoking
Article Date: 06 Nov 2007 - 7:00 PDT

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The ACP (American College of Physicians) has released its latest clinical practice guidelines for the diagnosis and treatment of COPD (chronic obstructive pulmonary disease). COPD is a lung disease which progresses slowly - lung function is progressively lost. COPD is more common among smokers.

The guidelines appear in Annals of Internal Medicine, November 6th, 2007 issue.

Over 5% of US adults have COPD. It is the fourth primary cause of death and the twelfth leading cause of illness in the USA. A COPD patient will typically have a chronic cough, wheezing - some patients may also have shortness of breath and considerable activity limitation.

Chronic bronchitis and emphysema are both types of COPDs. As patients usually have overlapping symptoms, it has become more common today for doctors to use the broader term COPD.

Some of the recommendations are:

-- If a patient has respiratory symptoms, in particular shortness of breath, Spirometry should be performed to diagnose airflow obstruction. Spirometry is a test - the patient blows into a machine which measures how much gas is breathed into it over a specified time. Asymptomatic patients should not undergo Spirometry.

-- 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.

-- Doctors should prescribe long-acting inhaled β-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids for patients with COPD symptoms and FEV1 of under 60% predicted.

-- If a patient's oxygen levels in the circulating blood (while resting) are insufficient doctors should prescribe oxygen therapy.

Guideline author, Steven Weinberger, MD, FACP, Senior Vice President, Medical Education and Publishing at ACP, said "The evidence does not support using Spirometry as a diagnostic strategy for individuals not reporting respiratory symptoms. However, adding Spirometry to clinical examinations for individuals with respiratory symptoms, especially shortness of breath, has demonstrated benefits."

The guidelines are 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.

Weinberger said "It is important that all individuals with COPD stop smoking to prevent progression of the disease. 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 guidelines are aimed at all doctors, while the target patient population is all COPD adult patients.

"Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline from the American College of Physicians"
Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Paul Shekelle, MD, PhD; Katherine Sherif, MD; Timothy J. Wilt, MD, MPH; Steven Weinberger, MD; Douglas K. Owens, MD, MS, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians*
Annals of Internal Medicine - 6 November 2007 | Volume 147 Issue 9 | Pages 633-638
Click here to view the guidelines online

"Management of Stable Chronic Obstructive Pulmonary Disease: A Systematic Review for a Clinical Practice Guideline"
Timothy J. Wilt, MD, MPH; Dennis Niewoehner, MD; Roderick MacDonald, MS; and Robert L. Kane, MD
Annals of Internal Medicine - 6 November 2007 | Volume 147 Issue 9 | Pages 639-653
Click here to view the guidelines online

Annals of Internal Medicine is published by the American College of Physicians, the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 124,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.

Written by - Christian Nordqvist
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