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Contents
Foreword
The COPD-X guidelines
Levels of evidence
Summary of the COPD-X guidelines
Confirm
diagnosis &
assess severity
Optimise function
Prevent deterioration
Develop support network
Manage eXacerbations
Appendices
References
References reviewed but not cited
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Refs 1-50
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Aetiology
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Summary
Summary of the COPD-X 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, the patient should be treated as for asthma
Consider COPD in patients with other smoking-related diseases
I
O: Optimise function
Evidence level
Inhaled bronchodilators provide symptom relief in patients with COPD and may increase exercise capacity
I
Long term use of systemic glucocorticoids is not recommended
I
Inhaled glucocorticoids should be considered in patients with severe COPD with 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
Evidence level
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 (> 15 h/day) prolongs life in hypoxaemic patients (PaO
2
< 55 mmHg, or 7.3 kPa)
I
D: Develop support network and self-management plan
Evidence level
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
X: Manage eXacerbations
Evidence level
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
Content last updated:
April 2009
Page last updated:
April 15, 2009