ATS GUIDELINES Bundle

Key Points ➤ The Global Initiative for Chronic Obstructive Lung Disease 2019 report defines chronic obstructive pulmonary disease (COPD) as a "common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases." ➤ Pharmacologic treatment for COPD aims to improve quality of life (QOL) and control symptoms while reducing the frequency of exacerbations. Table 1. Implications of Strong and Conditional Recommendations Strong Recommendation ("e ATS recommends...") Conditional Recommendation ("e ATS suggests...") Patients e overwhelming majority of individuals in this situation would want the recommended course of action, and only a small minority would not. (It is the right course of action for >95% of patients.) Most individuals in this situation would want the suggested course of action, but many would not. (It is the right course of action for >50% of patients.) Clinicians e overwhelming majority of individuals should receive the recommended course of action. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences. (It is reasonable to recommend it strongly to patients and caregivers.) Different choices will be appropriate for different patients, and the clinician must help each patient arrive at a management decision consistent with her or his values and preferences. Decision aids may be useful to help individuals make decisions consistent with their values and preferences. Clinicians should expect to spend more time with patients when working toward a decision. (Slow down, think about it, discuss it with the patient.) Policy makers e recommendation can be adopted as policy in most situations, including for use as a performance indicator. (e recommended course of action may be an appropriate performance measure.) Policy making will require substantial debates and involvement of many stakeholders. Policies are also more likely to vary between regions. Performance indicators would have to focus on the fact that adequate deliberation about the management options has taken place. (e recommended course of action is not appropriate for a performance measure.)

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