Summary of the major changes 

The COPD-X Plan: Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease, Version 2.26, August 2011

 Summary of major changes Version 2.26 August 2011.pdf 45.12 Kb

• C1 Aetiology and natural history - Update of Fig 3-1 Risk Factors for COPD based on GOLD, 2009.
• C1 Aetiology and natural history – Addition of sentence discussing development of a simplified Age, Dyspnoea score and Obstruction (ADO) index.
• C1 Aetiology and natural history – Addition of wording on possible differential benefit between men and women in relation to long term oxygen therapy.
• C3 Assessing the severity of COPD – Addition of sentence referring to use of British Thoracic Society classification.
• C5.1 Complex lung function tests – Rewording of section.
• O: Optimise function – Addition of sentence that adherence to inhaled medications is associated with reduced risk of death and admissions to hospital due to exacerbations.
• O1.2.1 Long-acting anticholinergics – Addition of sentence on decreased mortality with use of combination therapy with tiotropium, plus inhaled glucocorticoid and long-acting beta-agonist compared with combination therapy alone.
• O2.1 Methylxanthines – Addition of sentence recommending therapeutic drug monitoring of theophylline, plus wording on detection of pharmacokinetic interactions by looking at changes in plasma theophylline concentrations.
• O2.2 Phosphodiesterase type-4 inhibitors – Addition of wording on extension of placebo-controlled RCTs to 52 weeks, which confirm improvement in pre-bronchodilator FEV1 and reduction in annual rate of exacerbations with roflumilast
• O3.2 Inhaled glucocorticoids – Addition of wording discussing possible adverse effects, including discussion of evidence of relationship between glucocorticoid dose and glucose levels in diabetes patients.
• O4.1 Inhaled glucocorticoids and long-acting beta-agonists in combination – Rewording of sections discussing effects on exacerbation rates, all cause mortality and frequency of adverse events.
• O4.2 Inhaled glucocorticoids and long-acting beta-agonists and long-acting anticholinergics in combination – New section on “triple therapy” added.
• O6.1 Physical activity – New wording on benefits of regular physical activity.
• O6.3.1 Psychosocial support – Rewording of section.
• O6.5 Chest physiotherapy (Airway clearance techniques) – Rewording of section.
• O7.1 Cardiac disease – Addition of new section.
• O7.1.1 Heart failure – Addition of new section.
• O7.1.2 Safety of beta-blockers - Rewording of section.
• O7.1.3 Statins - Addition of new section.
• O7.1.4 Cardiac surgery - Addition of new section.
• O7.3 Osteoporosis – Addition of sentence on prevalence of osteoporosis in COPD and effects of salmeterol or fluticasone, or the combination, on bone mineral density compared with placebo.
• O9.2 Lung volume reduction surgery – Addition of sentence on effect of LVRS.
• P2.3 Haemophilus influenza vaccination – Additional sentence on benefits of vaccine.
• P5.1 Anticholinergics – Additional wording on tiotropium and confirming decreased risk of death, plus inclusion of NNTs and hazard ratios and wording discussing reduction in rate of decline of post-bronchodilator FEV1 in GOLDII COPD patients.
• P7 Mucolytic agents – Revision of statistics relating to mucolytic treatment based on updated Cochrane Review.
• D: Develop support network and self-management – Addition of sentence stating that severe COPD is associated with lower cognitive performance over time.
• D1.7 Clinical psychologist/psychiatrist – Rewording of section.
• D1.11 Exercise physiologist – Addition of wording relating to the role of exercise physiologists.
• D4 Treat anxiety and depression – Rewording of section.
• D5 Referral to a support group – Rewording of section.
• X: Manage eXacerbations – Addition of wording to advise consideration of pulmonary embolism in patients hospitalised with acute exacerbation.
• X2.2 Confirm exacerbation and categorise severity – Inclusion of wording on existence of simple clinical prediction score (BAP-65) to predict in-hospital mortality.
• X2.2.1 Inhaled bronchodilators for treatment of exacerbations – Addition of wording on effectiveness of dry powder inhalers in delivering short-acting bronchodilators in acute exacerbation.
• X2.2.2 Systemic glucocorticoids for treatment of exacerbations – Addition of wording comparing route of administration of glucocorticoids (oral vs. intravenous).
• X2.2.4 Combined systemic glucocorticoids and antibiotics for treatment of exacerbations – Addition of new section. 
• X3.4 Clearance of secretions – Rewording of section.