Key Points
ÎHistory and clinical examination are poor predictors of airflow obstruction (AO) and its severity.
ÎAdding spirometry to clinical examination for individuals with respiratory symptoms, especially dyspnea, has demonstrated benefits.
> Evidence does not support using spirometry as a diagnostic strategy for individuals not reporting respiratory symptoms.
ÎTreatment benefits for chronic obstructive pulmonary disease (COPD) are primarily related to reduced exacerbations among patients who are more likely to have exacerbations, dyspnea that limits activity, and severe to very severe AO.
ÎSmoking cessation is the single most effective — and cost effective — intervention in most people to reduce the risk of developing COPD and stop its progression (A).
ÎAcute exacerbations — the most frequent cause of medical visits, hospital admissions, and death among COPD patients — are preventable with optimal management of COPD.
ÎBronchodilator medications are central to the symptomatic management of COPD (A).
ÎInhaled corticosteroids (ICS) and long-acting bronchodilators are more effective in reducing exacerbations than are short-acting inhalers (A).
ÎA reduction in death is associated with the use of long-term supplemental oxygen therapy for patients with very severe AO and resting hypoxemia.
ÎMost studies have indicated that the existing medications for COPD do not modify the long-term decline in lung function that is the hallmark of this disease (A), although there is limited evidence that regular treatment with long-acting β-agonists, ICS, alone or in combination, can decrease the rate of decline of lung function (B).
ÎIt is essential to ensure that inhaler technique is correct and to re-check this at each visit.
Treatment Plan Mild
Moderate
Severe
Smoking cessation / Exercise / Self-management education SABD prn ► + SABA prn or LABA + SABD prn
LAAC or LABD + SABA ► LAAC + LABA + SABA prn ► LAAC + ICS/LABA (low dose) + SABA prn Pulmonary rehabilitation LAAC + ICS/LABA + SABA prn ► Add theophylline Oxygen Surgery
► = Persistent dyspnea
Very Severe
