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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, October 6, 2011

COPD Stable Chronic

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

Qaseem A, Wilt TJ, Weinberger SE, et al. Ann Intern Med. 2011;155:179-191
Study Summary: the updated chronic obstructive pulmonary disease (COPD) guidelines are official recommendations from the authoritative bodies in tne United states and Europe. They make 7 consensus recommendations and assign a grade to the evidence in favor of each recommendation on the basis of published research. The updated recommendations are:
  1. Spirometry should be used to diagnose and determine the severity of airflow obstruction, but only in patients with respiratory symptoms (evidence grade: strong).
  2. For patients whose COPD is stable and whose forced expiratory volume in 1 second of expiration (FEV1) is between 60% and 80% of predicted, treatment with inhaled bronchodilators may be used (grade: weak).
  3. For patients whose COPD is stable but whose FEV1 is less than 60% of predicted, inhaled bronchodilators should be used (grade: strong).
  4. For patients whose FEV1 is less than 60% of predicted, the recommendation is to prescribe long-acting monotherapy with either an inhaled anticholinergic agent or a beta-agonist, the choice being based on patient preference, cost, and adverse-effect profile (grade: strong).
  5. For patients whose FEV1 is less than 60% of predicted, an inhaled combination of 2 long-acting therapies including an anticholinergic agent, a beta-agonist, and/or an inhaled corticosteroid may be administered (grade: weak).
  6. For patients whose FEV1 is less than 50% of predicted and who are symptomatic, clinicians should prescribe pulmonary rehabilitation (grade: strong). They may consider pulmonary rehabilitation for symptomatic patients whose FEV1 is greater than 50% of predicted if the patient also has limitation of exercise capacity (grade: weak).
  7. Clinicians should prescribe continuous oxygen therapy in patients with COPD who have severe resting hypoxemia, including a partial pressure of oxygen in arterial blood (PaO2) of ≤ 55 mm Hg or an arterial saturation of ≤ 88% on room air (grade: strong).