Summary of the COPD-X guidelines

C: Confirm diagnosis and assess severity

Evidence level

• Smoking is the most important risk factor for COPD

• Consider COPD in patients with other smoking-related diseases

• Consider COPD in all smokers and ex-smokers older than 35 years

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

• If airflow limitation is fully or substantially reversible, the patient should be treated as for asthma

O: Optimise function

Evidence level

• Inhaled bronchodilators provide symptom relief in patients with COPD and may increase exercise capacity

• Long-acting bronchodilators provide sustained relief of symptoms in moderate to severe COPD

• Long term use of systemic glucocorticoids is not recommended

• Inhaled glucocorticoids should be considered in patients with a documented response or those who have severe COPD with frequent exacerbations

• Identify and treat hypoxaemia and pulmonary hypertension

• Prevent or treat osteoporosis

• Pulmonary rehabilitation reduces dyspnoea, anxiety and depression, improves exercise capacity and quality of life and may reduce hospitalisation

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

P: Prevent deterioration

Evidence level

• Smoking cessation reduces the rate of decline of lung function

• General practitioners and pharmacists can help smokers quit

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

• Pharmacotherapies double the success of quit attempts; behavioural techniques further increase the quit rate by up to 50%

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

• Long-term oxygen therapy (> 15 h/day) prolongs life in hypoxaemic patients (PaO₂ < 55 mmHg, or 7.3 kPa)

• Mucolytics may reduce the frequency and duration of exacerbations 

• Inhaled glucocorticoids are indicated for patients with a documented response or who have severe COPD with frequent exacerbations

D: Develop support network and self-management plan

Evidence level

• Pulmonary rehabilitation increases patient/carer knowledge base, reduces carer strain and develops positive attitudes towards self-management and exercise

• COPD imposes handicaps which affect both patients and carers 

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

• 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 professional disciplines

• Patients should be encouraged to take appropriate responsibility for their own management 

X: Manage eXacerbations

Evidence level

• Inhaled bronchodilators are effective treatments for acute exacerbations

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

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

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

• Multidisciplinary care may assist home management

• Early diagnosis and treatment may prevent admission

• Controlled oxygen oxygen in a pre-hospital setting is indicated for hypoxaemia

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