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ACP-ASIM Issues New Guideline for Pulmonary Disease

April 3, 2001

PHILADELPHIA -- (April 3, 2001) The American College of Physicians-American Society of Internal Medicine (ACP-ASIM) today released new guidelines for treatment of acute exacerbations, or flare-ups, of chronic obstructive pulmonary disease (COPD). The guidelines are published in today's Annals of Internal Medicine, the peer-reviewed journal published by ACP-ASIM.

The guidelines are a joint collaboration between ACP-ASIM and the American College of Chest Physicians (ACCP) and also will be published in the April issue of the ACCP journal CHEST.

The guidelines advise physicians on the best techniques to diagnose and manage COPD exacerbations in the hospital or emergency department. The guidelines include new information on using antibiotics and steroids, two common treatments. ACP-ASIM says that antibiotics are not needed for mild flare-ups and narrow-spectrum antibiotics, not the newer, more broad-spectrum antibiotics, should be used for severe flare-ups. The society also says that intravenous or oral corticosteroids are appropriate to lessen inflammation of the airway walls but should be used only for up to two weeks.

Chronic obstructive pulmonary disease decreases the lungs' ability to process air. It afflicts 16 million adults and accounts for 110,000 deaths, more than 16 million office visits, 500,000 hospitalizations and $18 billion in direct health care costs each year, according to U.S. government statistics.

COPD includes two major lung diseases: chronic bronchitis and emphysema. Although one type of emphysema is inherited, 80 to 90 percent of COPD cases are caused by smoking. Some people with COPD have only chronic bronchitis or emphysema, but most have some combination of both. COPD does not include other obstructive lung diseases such as asthma.

The initial signs of COPD are morning cough and shortness of breath. The disease, which is frequently fatal (COPD is the fourth leading cause of death in the United States), is progressive. Slow deterioration can sometimes go on for 20 years after first diagnosis. Many people with COPD become severely disabled, are unable to work, walk or leave the house. They may eventually require supplemental oxygen or mechanical respirators.

"COPD is a long-term, debilitating disease that robs millions of adults of useful years of productivity and good health. At present, there is no cure," says William J. Hall, MD, ACP-ASIM president. "Most COPD is caused by smoking, so the take-away message for patients and the public is not to smoke. If you haven't started smoking, don't start. If you smoke, quit. For those with COPD, quitting smoking will usually slow down the disease's progress."

The College's new guidelines are based on a systematic review in an Agency for Healthcare Research and Policy evidence report. ACP-ASIM has developed evidence-based clinical practice guidelines for more than 20 years. These are the first to address COPD.

"These evidence-based guidelines are important for showing not only what works but also what does not work in diagnosing and treating COPD exacerbations," says Vincenza Snow, MD, senior medical associate at ACP-ASIM. For example, the new guidelines say that:

  • Acute spirometry should not be used to diagnose an exacerbation or to asses its severity.
  • Mild to moderate exacerbations do not need antibiotics.
  • Newer broad-spectrum antibiotics, which are often used for severe COPD exacerbations, have not been shown to be superior to narrow-spectrum, more selective antibiotics.
  • Medications to clear mucus from the lungs, chest physiotherapy and methylxanthine bronchodilators are not beneficial; in fact, the latter two may be harmful.
  • There are no reliable methods of risk stratification for relapse or inpatient mortality.

In addition, the guideline panel did not find enough evidence to make any recommendations regarding use of pulse oximetry, sputum smear, and sputum culture, says Snow.

ACP-ASIM is a professional organization representing 115,000 internists, doctors for adults, and is the second largest medical organization in the United States. The ACCP has more than 15,000 members in more than 100 countries who specialize in various multidisciplinary areas of chest medicine.

NOTES to Editors:
Embargoed copies of the guideline and the background paper are available by calling Penelope Fuller at 215-351-2656 or 1-800-523-1546, ext. 2656.

The following people are available for interview by calling Susan Anderson at 215-351-2653 or 800-523-1546, ext. 2653: William J. Hall, MD, ACP-ASIM president; Vincenza Snow, MD, senior medical associate at ACP-ASIM, an author of the guidelines.

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