New clinical guideline issued on diagnosis, management of stable COPD

Several collaborating medical societies, including the American College of Physicians (ACP), released new guidelines this week on the diagnosis and management of stable chronic obstructive pulmonary disease (COPD).

The guideline, which updates and expands on a 2007 ACP guideline on this topic, was developed by a panel with members from ACP, the American College of Chest Physicians, the American Thoracic Society, and the European Respiratory Society, and represents an official, joint guideline from all four organizations. The panel helped develop key questions related to COPD diagnosis and management and evaluated related evidence reviews and tables to arrive at its recommendations, which were approved by unanimous vote. The guideline was published in the Aug. 2 Annals of Internal Medicine.

The guideline recommendations are as follows:

• Spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (strong recommendation, moderate-quality evidence) but should not be used to screen for airflow obstruction in individuals without respiratory symptoms (strong recommendation, moderate-quality evidence).
• For stable COPD patients with respiratory symptoms and FEV₁ between 60% and 80% predicted, possible treatment with inhaled bronchodilators is suggested (weak recommendation, low-quality evidence).
• For stable COPD patients with respiratory symptoms and FEV₁ less than 60% predicted, treatment with inhaled bronchodilators is recommended (strong recommendation, moderate-quality evidence).
• Clinicians should prescribe monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled β-agonists for symptomatic patients with COPD and FEV₁ less than 60% predicted (strong recommendation, moderate-quality evidence), and should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile.
• Clinicians may administer combination inhaled therapies (long-acting inhaled anticholinergics, long-acting inhaled β-agonists, or inhaled corticosteroids) for symptomatic patients with stable COPD and FEV₁ less than 60% predicted (weak recommendation, moderate-quality evidence).
• Clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV₁ less than 50% predicted (strong recommendation, moderate-quality evidence) and may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV₁ more than 50% predicted (weak recommendation, moderate-quality evidence).
• Clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (Pao₂ ≤55 mm Hg or Spo₂ ≤88%) (strong recommendation, moderate-quality evidence).