American College of Physicians Issues Comprehensive Guidelines for Diagnosis and Treatment of Stable Chronic Obstructive Pulmonary Disease
Long-acting inhaled therapies, supplemental oxygen, and pulmonary rehabilitation are beneficial for patients with COPD
PHILADELPHIA, Nov. 6, 2007 - The American College of Physicians (ACP) today released a new clinical practice guideline on diagnosing and treating stable chronic obstructive pulmonary disease (COPD), a slowly progressive lung disease involving the airways and lung tissue, resulting in a gradual loss of lung function, typically as a result of smoking.
COPD affects more than 5 percent of the adult population in the United States and is the fourth leading cause of death and twelfth leading cause of illness. The symptoms of COPD range from chronic cough and wheezing to more severe symptoms such as shortness of breath and significant activity limitation.
The term COPD includes both emphysema and chronic bronchitis. Physicians often use the broader term COPD, since affected patients frequently have components of both processes.
The guideline offers six recommendations, including:
In patients with respiratory symptoms, particularly shortness of breath, spirometry (a simple test in which a person blows into a machine that measures the amount of gas breathed into it over a period of time) should be performed to diagnose airflow obstruction. Spirometry should not be used to screen for airflow obstruction in asymptomatic individuals.
Treatment of stable COPD should be reserved for patients who have respiratory symptoms and forced expiratory volume in one second (FEV1) less than 60 percent predicted, as documented by spirometry.
For symptomatic patients with COPD and FEV1 less than 60 percent predicted, clinicians should prescribe long-acting inhaled β-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids.
Clinicians should prescribe oxygen therapy in patients with COPD and insufficient levels of oxygen in the circulating blood while resting.
“The evidence does not support using spirometry as a diagnostic strategy for individuals not reporting respiratory symptoms,” said Steven Weinberger, MD, FACP, Senior Vice President, Medical Education and Publishing at ACP, and an author of the guideline. “However, adding spirometry to clinical examinations for individuals with respiratory symptoms, especially shortness of breath, has demonstrated benefits.”
The guideline, published in the Nov. 6, 2007, issue of Annals of Internal Medicine, is based on a systematic evidence review of published studies by Timothy J. Wilt, MD, MPH, and the Agency for Healthcare Research and Quality-sponsored Minnesota Evidence-based Practice Center evidence report.
“It is important that all individuals with COPD stop smoking to prevent progression of the disease,” Dr. Weinberger said. “Of course, even smokers without COPD should stop smoking to decrease the risk of both COPD and lung cancer. It’s never too late to stop.”
The target audience for the guideline is all physicians and the target patient population is all adults with COPD.
The following will be published in the in the Nov. 6, 2007, edition of Annals of Internal Medicine and will be available to the public at www.annals.org:
Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline from the American College of Physicians
Management of Stable Chronic Obstructive Pulmonary Disease: A Systematic Review for a Clinical Practice Guideline
Annals of Internal Medicine (www.annals.org) is one of the most widely cited peer-reviewed medical journals in the world. The journal has been published for 80 years and accepts only seven percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (www.acponline.org), the largest medical specialty organization and the second-largest physician group in the United States.
ACP members include 124,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.