A guest column by the American College of Physicians, exclusive to KevinMD.com.
It is easy to continue practice patterns we establish over the years. In my daily life as a general internist I am more likely to look for more information on a condition I don’t see regularly than on one that I see all the time. While we want to provide the best care for every condition we treat we may have more opportunities to impact the lives of those we care for by paying special attention to the latest evidence-based guidelines on common conditions we see every day.
In that spirit, the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS) have released a joint clinical practice guideline on diagnosing and treating stable chronic obstructive pulmonary disease (COPD) in Annals of Internal Medicine. ACP convened the four organizations to develop the joint guideline.
COPD is the third leading cause of death and 12th leading cause of illness in the United States. Because many patients are not getting appropriate care, the guideline aims to help clinicians diagnose and manage stable COPD, prevent and treat exacerbations, reduce hospitalizations and deaths, and improve the quality of life of patients with COPD.
The guideline makes the following recommendations:
- Spirometry should only be obtained to diagnose airflow obstruction in patients with respiratory symptoms and not in patients without symptoms even in the presence of risk factors.
- For stable COPD patients with respiratory symptoms and FEV1 between 60% and 80% predicted, physicians may treat these patients with inhaled bronchodilators.
- In patients with FEV1 less than 60% predicted, clinicians should prescribe monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled beta agonists. Consider a combination of inhaled drugs (long-acting inhaled anticholinergic, long-acting inhaled beta agonist, or inhaled corticosteroid) if symptoms continue during treatment with one drug.
- Pulmonary rehabilitation is recommended in symptomatic patients with severe COPD (FEV1<50%) and may be considered in symptomatic or exercise-limited patients with less severe airflow obstruction.
- In patients who have severe resting hypoxemia and SpO2 of 88% or less, continuous oxygen therapy should be used.
While COPD might not get the same attention as lung cancer and heart disease, it is important for physicians to help their patients to stop smoking to prevent this disease or its progression.
In addition to the guideline, the following resources are available:
Fred Ralston practices internal medicine in Fayetteville, Tennessee, and is the Immediate Past President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.
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