Australian and New Zealand Guidelines for the management of Chronic Obstructive Pulmonary Disease

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COPD-X Plan Guidelines
  • COPD-X Plan Guidelines
  • Introduction
  • Key Recommendations
    • Levels of evidence
  • Clinical Summary Tools
  • C: Case finding and confirm diagnosis
    • C1. Aetiology and natural history
      • C1.1 Natural history
    • C2. Diagnosis
      • C2.1 History
      • C2.2 Physical examination
      • C2.3 Spirometry
      • C2.6 Incidental findings (National Lung Cancer Screening Program)
      • C2.4 Flow volume tests
      • C2.5 COPD case finding
    • C3. Assessing the severity of COPD
    • C4. Assessing acute response to bronchodilators
      • C4.1 Confirm or exclude asthma
    • C5. Further investigations
    • C6. Specialist referral
  • O: Optimise function
    • O1. Inhaled bronchodilators
      • O1.1 Short-acting bronchodilators
        • O1.1.1 Short-acting beta2-agonists (SABA)
        • O1.1.2 Short-acting muscarinic antagonist (SAMA)
        • O1.1.3 Short-acting bronchodilator combinations
      • O1.2 Long-acting bronchodilators
        • O1.2.1 Long-acting muscarinic antagonists (LAMA)
        • O1.2.2 Long-acting beta2-agonists (LABA)
        • O1.2.3 Long-acting bronchodilator combinations (LAMA/LABA)
      • O1.3 Assessment of response and continuation of bronchodilator therapy
    • O2. Oral bronchodilators
      • O2.1 Methylxanthines
      • O2.2 Phosphodiesterase type-4 inhibitors
    • O3. Corticosteroids
      • O3.1 Oral corticosteroids
      • O3.2 Inhaled corticosteroids (ICS)
      • O3.3 Inhaled corticosteroids versus long-acting beta2-agonists
    • O4. Combination therapies and biologic therapies
      • O4.1 Inhaled corticosteroids and long-acting beta2-agonists in combination (ICS/LABA)
      • O4.2 Inhaled corticosteroids and long-acting beta2-agonists and long-acting antimuscarinics in combination
        • O4.2.1 ICS/LABA/LAMA vs LABA/LAMA
        • O4.2.2 ICS/LABA/LAMA vs ICS/LAMA
        • O4.2.3 Fixed vs open triple therapy
        • O4.2.4 Prescribing and availability
      • O4.3 Eosinophils
      • O4.4 Biologic therapies
    • O5. Inhaler use
    • O6. Non-pharmacological interventions
      • O6.1 Pulmonary rehabilitation
      • O6.2 Exercise training
      • O6.3 Inspiratory Muscle Training
      • O6.4 Neuromuscular Electrical Stimulation
      • O6.5 Physical activity and sedentary behaviour
      • O6.6 Education and self-management
        • O6.6.1 Psychosocial support
      • O6.7 Breathing exercises
      • O6.8 Chest physiotherapy (Airway clearance techniques)
      • O6.9 Smoking cessation
      • O6.10 Nutrition
      • O6.11 Complementary therapies
    • O7. Comorbidities
      • O7.1 Increased risks from comorbidities in the presence of COPD
      • O7.2 Cardiac disease
        • O7.2.1 Heart failure
        • O7.2.2 Safety of beta-blockers
        • O7.2.3 Stroke
        • O7.2.4 Statins
        • O7.2.5 Coronary revascularisation procedures
      • O7.3 Osteoporosis
      • O7.4 Frailty in COPD
      • O7.5 Falls in COPD
      • O7.6 Sleep related breathing disorders
      • O7.7 Aspiration
      • O7.8 Gastro-oesophageal reflux disease (GORD)
      • O7.9 Lung Cancer
      • O7.10 Bronchiectasis
      • O7.11 Combined pulmonary fibrosis and emphysema
      • O7.12 Alcohol and sedatives
      • O7.13 Testosterone deficiencies and supplementation
      • O7.14 Cognitive Impairment
      • O7.15 Anaemia
    • O8. Hypoxaemia and pulmonary hypertension
      • O8.1 Treatment of hypoxaemia and pulmonary hypertension
    • O9. Surgery
      • O9.1 Bullectomy
      • O9.2 Lung volume reduction surgery and bronchoscopic interventions
      • O9.3 Lung Transplantation
      • O9.4 Pre-operative work-up surgery
    • O10. Palliative and supportive care
  • P: Prevent deterioration
    • P1. Risk factor reduction
      • P1.1 Smoking cessation
      • P1.2 Treatment of nicotine dependence
        • P1.2.1 Nicotine replacement therapy
        • P1.2.2 Nicotine Receptor Partial Agonists
        • P1.2.3 Antidepressants
        • P1.2.4 Other agents
        • P1.2.5 Electronic cigarettes (e-cigarettes)
      • P1.3 Prevent smoking relapse
    • P2. Immunisations
      • P2.1 Influenza immunisation
      • P2.2 Pneumococcal immunisation
      • P2.3 Haemophilus influenzae immunisation
      • P2.4 Respiratory syncytial virus immunisation
    • P3. Immuno-modulatory agents
    • P4. Macrolides
    • P5. Long-acting bronchodilators
    • P6. Corticosteroids
    • P7. Mucolytic agents
    • P8. Humidification therapy and nasal high flow (NHF) therapy
    • P9. Regular review
    • P10. Oxygen therapy
      • P10.1 Fitness to fly
    • P11 Long-term home non-invasive ventilation
    • P12 Alpha1-antitrypsin deficiency
  • D: Develop a plan of care
    • D1. Support team
      • D1.1 General Practitioner
      • D1.2 Other specialist physicians
      • D1.3 GP practice nurse/ nurse practitioner/ respiratory educator/ respiratory nurse
      • D1.4 Physiotherapist
      • D1.5 Occupational therapist
      • D1.6 Social worker
      • D1.7 Clinical psychologist/psychiatrist
      • D1.8 Speech pathologist/therapist
      • D1.9 Pharmacist
      • D1.10 Dietitian/Nutritionist
      • D1.11 Exercise physiologist
      • D1.12 Non-medical care agencies
    • D2. Multidisciplinary care plans
    • D3. Self-management
      • D3.1 Maintenance therapy
      • D3.2 Exacerbation prevention
    • D4. Telehealth
    • D5. Assessment and management of anxiety and depression
    • D6. Referral to a support group
  • X: Manage eXacerbations
    • X1. Home management
    • X2. COPD exacerbation management
      • X2.1 Confirm exacerbation and categorise severity
      • X2.2 Optimise treatment
    • X3. Refer appropriately to prevent further deterioration (‘P’)
      • X3.1 Controlled oxygen delivery
      • X3.2 Non-invasive ventilation
      • X3.3 Invasive ventilation (intubation)
      • X3.4 Clearance of secretions
      • X3.5 Develop post-discharge plan and follow-up
      • X3.6 Pulmonary rehabilitation
      • X3.7 Discharge planning
      • X3.8 Support after discharge
      • X3.9 Clinical review and follow-up
    • X4. Uptake and impact of guidelines for exacerbations
  • Appendix
  • List of Figures
  • List of Boxes
  • Glossary of Terms
  • Acknowledgements
    • Other contributors – Past and Present
    • Conflicts of Interest
      • COPD-X Handbook Conflicts of Interest
      • Support for COPD-X
  • References
    • References A-G
    • References H-R
    • References S-Z
  • The COPD-X Plan Version Archives

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Version 2.78 Published December 2025
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