New COPD guidelines make seven recommendations
Three organizations have joined forces with the American College of Physicians (ACP) to update the ACP 2007 clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease.
The ACP, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society conducted a targeted literature update from March 2007 to December 2009 in order to formulate the following seven recommendations for clinicians managing persons with COPD:
- Spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms, but should not be used to screen for such obstruction in persons without respiratory symptoms.
- Inhaled bronchodilators are suggested for stable COPD patients with respiratory symptoms and forced expiratory volume in 1 second (FEV1) between 60% and 80% predicted.
- Inhaled bronchodilators are recommended for stable COPD patients with respiratory symptoms and FEV1 <60% predicted.
- Monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled beta-agonists should be prescribed for symptomatic COPD patients with FEV1 <60% predicted.
- Combination inhaled therapies (long-acting inhaled anticholinergics, long-acting inhaled beta-agonists, or inhaled corticosteroids) may be administered for symptomatic patients with stable COPD and FEV1 <60% predicted.
- Clinicians should proscribe pulmonary rehabilitation for symptomatic patients with an FEV1 <50% predicted, and may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV1 >50% predicted.
- Continuous oxygen therapy should be prescribed for COPD patients who have severe resting hypoxemia.
In addition, a recent study showed that adding 250 mg of azithromycin (Zithromax, Zmax) to the usual daily treatment regimen for COPD for one year reduced acute COPD exacerbations from an annual average of 1.83 to 1.48 among 572 participants (N Engl J Med. 2011;365:689-698).