The COPD-X
guidelines
These guidelines are the outcome of a joint project of the Thoracic
Society of Australia and New Zealand and the Australian Lung Foundation. The
guidelines aim to:
- effect changes in
clinical practice based on sound
evidence; and
- shift the emphasis
from a predominant reliance on
pharmacological treatment of
COPD to a range of interventions
which include patient education,
self-management of exacerbations
and pulmonary rehabilitation.
These
guidelines deal mainly with the
management of established disease
and exacerbations. However, this is
only one element of the COPD
Strategy of the Australian Lung
Foundation, which has the long-term
goals of:
- primary prevention
of smoking;
- improving rates of
smoking cessation;
- early detection of
airflow limitation in smokers
before disablement; and
- improved management
of stable disease and prevention
of exacerbations.
In May 2001 a multidisciplinary steering committee was convened by
the Thoracic Society of Australia and New Zealand (TSANZ) and the Australian
Lung Foundation in accordance with the National Health and Medical Research
Council recommendations for guideline development.5
The Committee agreed to use the Global Initiative for Chronic Obstructive Lung
Disease (GOLD) Workshop Report6
as the prime evidence base, together with systematic reviews and meta-analyses
from the Cochrane Database. The GOLD Report, released in April 2001, was
produced by an international panel of experts in collaboration with the United
States National Heart, Lung, and Blood Institute (NHLBI) and the World Health
Organization (WHO). The levels of evidence in the current guidelines were
assigned according to the system developed by the NHLBI (Box
1). ). Any changes to the guidelines have been based on subsequent versions
of the GOLD report and on the
results of systematic reviews or
consistent evidence from well
conducted randomised controlled
trials.
The Guidelines Steering Committee supervised the development of
specific items such as the COPDX Plan and a management handbook for primary care
clinicians. Drafts of these documents were widely circulated to key stakeholder
groups and professional organisations. In addition, the draft guidelines were
published on the Internet (http://www.lungnet.com.au/content/view/1/3/), and access to
them was advertised in a national newspaper. The draft guidelines were
circulated to all members of the TSANZ and Australian Divisions of General
Practice. All comments received were reviewed by the Steering Committee. The
Guidelines were then published as a supplement to The Medical Journal of
Australia in March 2003.
The Steering Committee then
resolved to establish a COPD
Guidelines Committee
and a Guidelines Evaluation
Committee. The terms of reference of
the Evaluation Committee included
scientific assessment of the impact
of the guidelines on clinical
practice and rigorous examination of
the relevant medical literature to
ensure the guidelines remain up to
date. Any suggested modifications
have been circulated to members of
the COPD Coordinating Implementation
Committee and other key stakeholders
prior to ratification. This version
of the guidelines has been submitted
to the COPD Special Interest Group
of the Thoracic Society of Australia
and New Zealand for endorsement.
Associate Professor
David K McKenzie and
Professor Peter Frith
Principal authors and members of the
COPD Implementation Committee.
July 2005
Logistical and financial support for the development of these
guidelines was provided by the Australian Lung Foundation as part of its COPD
program. This program is funded by non-tied program support grants from Boehringer Ingelheim Pty Ltd
(North Ryde, NSW), GlaxoSmithKline Australia Pty Ltd (Boronia, VIC), Pfizer
Australia (West Ryde, NSW), and Air Liquide Healthcare Pty Ltd (Alexandria, NSW)
Associate Professor
David K McKenzie
Chair, COPD Guidelines Steering
Committee
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