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Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline Update from the American College of Physicians, American College of Chest Physicians, American Thoracic Society, and European Respiratory Society

American College of Physicians and Temple University, Philadelphia, Pennsylvania 19106, USA.
Annals of internal medicine (Impact Factor: 16.1). 08/2011; 155(3):179-91. DOI: 10.1059/0003-4819-155-3-201108020-00008
Source: PubMed

ABSTRACT DESCRIPTION: This guideline is an official statement of the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS). It represents an update of the 2007 ACP clinical practice guideline on diagnosis and management of stable chronic obstructive pulmonary disease (COPD) and is intended for clinicians who manage patients with COPD. This guideline addresses the value of history and physical examination for predicting airflow obstruction; the value of spirometry for screening or diagnosis of COPD; and COPD management strategies, specifically evaluation of various inhaled therapies (anticholinergics, long-acting β-agonists, and corticosteroids), pulmonary rehabilitation programs, and supplemental oxygen therapy. METHODS: This guideline is based on a targeted literature update from March 2007 to December 2009 to evaluate the evidence and update the 2007 ACP clinical practice guideline on diagnosis and management of stable COPD. RECOMMENDATION 1: ACP, ACCP, ATS, and ERS recommend that spirometry should be obtained to diagnose airflow obstruction in patients with respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). Spirometry should not be used to screen for airflow obstruction in individuals without respiratory symptoms (Grade: strong recommendation, moderate-quality evidence). RECOMMENDATION 2: For stable COPD patients with respiratory symptoms and FEV(1) between 60% and 80% predicted, ACP, ACCP, ATS, and ERS suggest that treatment with inhaled bronchodilators may be used (Grade: weak recommendation, low-quality evidence). RECOMMENDATION 3: For stable COPD patients with respiratory symptoms and FEV(1) <60% predicted, ACP, ACCP, ATS, and ERS recommend treatment with inhaled bronchodilators (Grade: strong recommendation, moderate-quality evidence). RECOMMENDATION 4: ACP, ACCP, ATS, and ERS recommend that clinicians prescribe monotherapy using either long-acting inhaled anticholinergics or long-acting inhaled β-agonists for symptomatic patients with COPD and FEV(1) <60% predicted. (Grade: strong recommendation, moderate-quality evidence). Clinicians should base the choice of specific monotherapy on patient preference, cost, and adverse effect profile. RECOMMENDATION 5: ACP, ACCP, ATS, and ERS suggest that clinicians may administer combination inhaled therapies (long-acting inhaled anticholinergics, long-acting inhaled β-agonists, or inhaled corticosteroids) for symptomatic patients with stable COPD and FEV(1)<60% predicted (Grade: weak recommendation, moderate-quality evidence). RECOMMENDATION 6: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe pulmonary rehabilitation for symptomatic patients with an FEV(1) <50% predicted (Grade: strong recommendation, moderate-quality evidence). Clinicians may consider pulmonary rehabilitation for symptomatic or exercise-limited patients with an FEV(1) >50% predicted. (Grade: weak recommendation, moderate-quality evidence). RECOMMENDATION 7: ACP, ACCP, ATS, and ERS recommend that clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia (Pao(2) ≤55 mm Hg or Spo(2) ≤88%) (Grade: strong recommendation, moderate-quality evidence).

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Available from: Holger J Schünemann, Aug 19, 2015
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    • "The diagnosis of COPD is based on evidence of pulmonary obstruction, in combination with signs and symptoms suggestive of COPD and with history of smoking [9]. Pathophysiologically, it is well established that COPD can be partly considered as accelerated ageing of the lungs and thus its prevalence increases with age [10]. "
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a very common lung disease most often related to history of smoking. It becomes more prevalent with increasing age but remains under-diagnosed and under-treated in the elderly population. Under diagnosis of COPD is universal in elderly patients because of multiple pathology, difficulty with measurement of lung function, under-reporting of symptoms and reduced perception of dyspnoea. However the screening of the elderly (age >60 years) is not performed routinely even when they are symptomatic.
    03/2015; 25. DOI:10.1016/j.ejcdt.2015.03.010
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    • "Chronic obstructive pulmonary disease (COPD) is a progressive lung disease affecting the airways and/or lung parenchyma of primarily older adults that results in a mostly irreversible airway obstruction [1] [2]. Pathophysiological consequences of COPD include skeletal muscle deconditioning, ventilatory and gas exchange impairments resulting in tissue hypoxia, and psychological disturbances all of which result in a shortness of breath (dyspnea) and a poor exercise tolerance . "
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    ABSTRACT: • Dietary nitrate consumption increases plasma nitrate and nitrite levels in chronic obstructive disease (COPD) patients.• Dietary nitrate consumption increases submaximal exercise capacity in COPD patients.• Dietary nitrate consumption decreases resting systolic blood pressure in COPD patients.• Dietary nitrate consumption decreases exercise diastolic blood pressure in COPD patients.
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    • "Another study suggested that depression has a possible causal effect on COPD exacerbations and hospitalizations [12]. Furthermore, recent data indicate that mortality risk is three times greater in COPD patients who had depressive symptoms in one series [13]. In this work, we evaluate the effect of treatment of anxiety and depression on the physiological status in severe COPD patients. "
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    ABSTRACT: Background Anxiety and depression are mental health problems that result in reduced health-related quality of life (HRQL), and increased mortality. Patients with COPD have a higher risk of anxiety and depression compared to healthy individuals. Recent studies reported a significant relationship between the presence of anxiety and depression and the functional status of COPD patients. Objectives To study the effect of treatment of anxiety and depression on the physiological status in COPD patients. Materials and methods The study included 50 severe COPD patients with depression and/or anxiety as evaluated and scored by Montgomery and Asberg Depression Rating Scale (MADRS) and Hamilton Anxiety Rating (HAM-A) Scale. They were classified into 2 groups: group I included 25 patients who received antidepressant/anxiolytic therapy in addition to COPD treatment and group II included 25 patients who received COPD treatment only. Modified Borg scale dyspnea score, spirometry (vital capacity, forced vital capacity, forced expiratory volume in first second and forced expiratory flow through 25–75% of expiration), arterial blood, MADRS and HAM-A scale were assessed in all patients at the start of the study and after 3 months. Results Patients with severe COPD who were treated for depression and/or anxiety showed a significant improvement in MADRS, HAM-A and dyspnea scales, spirometeric parameters and oxygenation. MADRS and HAM-A scale showed a significant negative correlation to FEV1. Conclusion Treatment of depression and anxiety in COPD patients is recommended as it is associated with a significant improvement in pulmonary physiological status and HRQL. Further studies on larger scales are recommended.
    09/2014; 64(1). DOI:10.1016/j.ejcdt.2014.08.006
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