New, Collaborative COPD Treatment Guidelines

Four physician organizations -- the American Thoracic Society (ATS,) the American College of Chest Physicians (ACCP,) the European Respiratory Society (ERS) and the American College of Physicians (ACP) -- have collaborated together to release updated clinical practice guidelines regarding the diagnosis and treatment of COPD.

"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 Amir Qaseem, MD, FACP, PhD, Director of Clinical Policy, American College of Physicians and lead author. "It is important for patients with COPD to stop smoking and for physicians to help their patients to quit smoking."

What do the clinical guidelines include? Here are the collaborative recommendations:

• 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 and that routine use, amongst other things, leads to unnecessary testing, costs and disease labeling.
• For stable COPD patients with respiratory symptoms and FEV1 (forced expiratory volume in 1 second as measured by spirometry) between 60 percent and 80 percent predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used.
• 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.

What do you think of the latest recommendations? Are they really much different than what physicians have been doing all along? Before you answer, you may want to check out current GOLD treatment guidelines updated in 2010.

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_Source:

_{American College of Physicians Press Release}