New COPD guidelines aim to manage patients better

New guidelines for chronic obstructive pulmonary disease recommend that physicians use spirometry to diagnose airflow obstruction in patients with respiratory symptoms such as wheezing, shortness of breath and chronic cough. The screen, however, should not be performed in asymptomatic people, because it could lead to unnecessary testing and increased health care costs, among other things.

Doctors also are urged to be alert for respiratory symptoms in patients who smoke, because cigarette smoking is the leading cause of COPD, according to the National Heart, Lung and Blood Institute. They should talk to such patients about the harms of smoking and help them quit the habit, said lead guidelines author Amir Qaseem, MD, PhD.

Long-term exposure to other lung irritants, such as air pollution, chemical fumes and dust, also might contribute to developing the disease, the institute said.

The recommendations, published in the Aug. 2 issue of Annals of Internal Medicine, were developed by the American College of Physicians, American College of Chest Physicians, American Thoracic Society and European Respiratory Society (link). They are based on studies published between March 2007 and December 2009, and they update guidance issued by the ACP in 2007.

"COPD is the third-leading cause of death and the 12th-leading cause of morbidity in the U.S.," said Dr. Qaseem, director of clinical policy at the ACP. "But many patients [with the disease] are not getting appropriate care."

He said some physicians do not know how to appropriately manage patients with the disease, and many individuals unknowingly have the condition and do not seek medical care.

"The 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," Dr. Qaseem said.

More than 12 million Americans have been diagnosed with the condition, and many more probably have the disease but do not know it, said the National Heart Lung and Blood Institute.

For COPD patients who have respiratory symptoms and forced expiratory volume in one second between 60% and 80% predicted, physicians should prescribe an inhaled bronchodilator, according to the new guidelines. The same treatment is recommended for symptomatic people with an FEV1 less than 60% predicted. When the monotherapy is not effective, or if the symptoms continue in such patients, the guidelines encourage doctors to administer combination inhaled therapies.

Pulmonary rehabilitation is suggested for symptomatic patients with an FEV1 less than 50% predicted. Patients who have severe resting hypoxemia should receive continuous oxygen therapy, the recommendations said.