02 August 2011

New guidelines for COPD released

Four of the world's leading pulmonary associations have issued new guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), one of the world's leading killers.


Four of the world's leading pulmonary associations have issued new guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease (COPD), one of the world's leading killers.

While the recommendations are based on more recent studies of the disorder, they differ little from previous guidelines and are meant largely to emphasise how critical it is to manage the disease to reduce hospitalisations, exacerbations and deaths, said lead author Dr Amir Qaseem, director of clinical policy in the medical education division of the American College of Physicians, one of the four sponsoring organisations.

"We're repeating the message. Chronic obstructive pulmonary disease is the third leading cause of death and . . . the number keeps going up. In 2007, it was the fifth leading cause of death," said Qaseem. "Many patients are still not getting the appropriate care."

Stop smoking if you have COPD

The main advice of pulmonologists worldwide is not surprising: quit smoking, especially if you've already been diagnosed with COPD. Smoking is the leading risk factor for COPD.

"Smoking cessation remains key," said Dr Sandhya Khurana, an assistant professor of medicine in the pulmonary and critical care division at the University of Rochester Medical Center in New York.

And lung damage, once it occurs, is irreversible, said Khurana, who was not involved with the study that appears in the Annals of Internal Medicine.

COPD is caused by inflammation and constriction of the air passages. Symptoms include trouble breathing, shortness of breath with physical activity, chronic cough and wheezing.

The authors recommended that spirometry should only be used to diagnose COPD in patients who already have symptoms. Spirometry is a pulmonary function test which measures how much air a person expels while exhaling (a measure called FEV1). "Spirometry is not beneficial in patients who do not have respiratory symptoms even if they have risk factors," Qaseem said.

Patients with COPD who don't have symptoms shouldn't be treated as no real benefit has been shown.

Patients whose FEV1 is less than 60 percent and who also have symptoms can get better outcomes with inhaled beta-agonists, anticholinergics and corticosteroids.

These same drugs may benefit patients with an FEV1 of 60 to 80%, though the evidence here is not as strong. When FEV1 drops below 50%, patients with symptoms may benefit from pulmonary rehabilitation. And for patients who have severe shortness of breath, doctors should prescribe oxygen.

More information

The American Lung Association has more on COPD.

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