Executive Summary of the COPDX guidelines

C: Confirm diagnosis and assess severity

Evidence level

• Smoking is the most important risk factor in the development of COPD

I

• Consider COPD in all smokers and ex-smokers over the age of 35 years

II

• The diagnosis of COPD rests on the demonstration of airflow limitation which is not fully reversible

II

• If airflow limitation is fully or substantially reversible (FEV₁ response to bronchodilator>400ml), the patient should be treated as for asthma

• Consider COPD in patients with other smoking-related diseases

I

O: Optimise function

• Inhaled bronchodilators provide symptom relief and may increase exercise capacity

I

• Long term use of systemic glucocorticoids is not recommended

I

• Inhaled glucocorticoids should be considered in patients with moderate to severe COPD and frequent exacerbations

I

• Pulmonary rehabilitation reduces dyspnoea, fatigue, anxiety and depression, improves exercise capacity, emotional function and health-related quality of life and enhances patients’ sense of control over their condition

I

• Pulmonary rehabilitation reduces hospitalisation and has been shown to be cost-effective

II

• Prevent or treat osteoporosis

• Identify and treat hypoxaemia and pulmonary hypertension

I

• In selected patients, a surgical approach may be considered for symptom relief

III-2

P: Prevent deterioration

• Smoking cessation reduces the rate of decline of lung function

I

• Treatment of nicotine dependence is effective and should be offered to smokers in addition to counselling

I

• Influenza vaccination reduces the risk of exacerbations, hospitalisation and death

I

• Mucolytics may reduce the frequency and duration of exacerbations

II

• Long-term oxygen therapy (>15h/day) prolongs life in hypoxaemic patients (Pao2 <55mmHg, or 7.3kPa)

I

D: Develop support network and self-management

• COPD imposes handicaps which affect both patients and carers

II

• Enhancing quality of life and reducing handicap requires a support team

• Patients and their family/friends should be actively involved in a therapeutic partnership with a range of health professionals

II

• Multidisciplinary care plans and individual self-management plans may help to prevent or manage crises

III-2

• Patients who take appropriate responsibility for their own management may have improved outcomes

III-1

• Anxious and depressive symptoms and disorders are common comorbidities in people with COPD

l

X: Manage eXacerbations

• An exacerbation is an event in the natural course of the disease characterised by a change in the patient's baseline dyspnoea, cough and/or sputum that is beyond normal day to day variations, is acute in onset and may warrant a change in regular medication in a patient with underlying COPD

• Early diagnosis and treatment may prevent admission

III-2

• Multidisciplinary care may assist home management

II

• Inhaled bronchodilators are effective treatments for acute exacerbations

I

• Systemic glucocorticoids reduce the severity of and shorten recovery from acute exacerbations

I

• Exacerbations with clinical signs of infection (increased volume and change in colour of sputum and/or fever, leukocytosis) benefit from antibiotic therapy

II

• Controlled oxygen delivery (28%, or 0.5-2.0L/min) is indicated for hypoxaemia

• Non-invasive positive pressure ventilation is effective for acute hypercapnic ventilatory failure

I

• Involving the patient’s general practitioner in a case conference and developing a care plan may facilitate early discharge