Key Recommendations of the COPD-X Guidelines
| LoE | SoR |
|---|---|---|
| Smoking is the most important risk factor for developing COPD | I | Strong |
| Smoking cessation reduces mortality in people with COPD | I | Strong |
| Begin with a thorough history and examination for COPD as the first step to diagnosis | III-2 | Strong |
| Confirm COPD with spirometry (post-bronchodilator FEV₁/FVC <0.7) | III-2 | Strong |
| While a large increase in post-bronchodilator FEV₁ (with greater confidence if increase is >15% and >400mL) might suggest asthma or coexisting asthma and COPD, consider patient history, pattern of symptoms, and further investigations to confirm diagnosis (GINA 2023) | III-2 | Strong |
| Further investigations may be necessary to confirm or exclude other conditions and assess COPD severity | III-2 | Strong |
| Consider referral to specialist respiratory services if needed | III-2 | Strong |
| Regularly assess COPD symptoms and exacerbation risk | III-2 | Strong |
SoR = Strength of recommendation according to the GRADE (Andrews 2013, Guyatt 2008)
Key Recommendations for O: Optimise function | LoE | SoR |
|---|---|---|
| Begin with a comprehensive assessment as the first step to optimising function | III-2 | Strong |
| Recognise that comorbid conditions are common in patients with COPD | III-2 | Strong |
| Regularly check inhaler technique and adherence | I | Strong |
| Optimise pharmacotherapy using a stepwise approach | I | Strong |
| Recommend non-pharmacological strategies such as pulmonary rehabilitation and regular exercise to anyone with COPD | I | Strong |
| Refer to pulmonary rehabilitation to improve quality of life, exercise capacity, and reduce COPD exacerbations | I | Strong |
| Lung volume reduction (surgical and endobronchial) can enhance lung function, exercise capacity and quality of life | I | Weak |
| Consider palliative care early, ideally from a multidisciplinary team, to control symptoms and to address psychosocial issues | II | Weak |
SoR = Strength of recommendation according to the GRADE system (Andrews 2013, Guyatt 2008)
Key Recommendations for P: Prevent deterioration | LoE | SoR |
|---|---|---|
| Focus on reducing the risk of exacerbations to prevent deterioration | III-2 | Strong |
| Emphasise smoking cessation as the most important intervention to prevent worsening of COPD | II | Strong |
| Encourage vaccination to reduce risks associated with influenza, pneumococcal and SARS-CoV-2 (COVID-19) infection | I | Strong |
| Consider long-term macrolide antibiotics in people with moderate to severe COPD and frequent exacerbations | I | Weak |
| Consider long-term oxygen therapy for patients with COPD with resting hypoxaemia | I | Strong |
| Consider long-term non-invasive ventilation in people with stable COPD and hypercapnia to reduce mortality and hospital admissions | I | Weak |
| Mucolytics may reduce exacerbations in patients with COPD | I | Strong |
SoR = Strength of recommendation according to the GRADE system (Andrews 2013, Guyatt 2008)
Key Recommendations for D: Develop a plan of care | LoE | SoR |
|---|---|---|
| Anticipate the wide range of needs for patients with COPD to facilitate good chronic disease care | I | Strong |
| Clinical support teams working with the primary healthcare team can help enhance quality of life and reduce disability | III-2 | Weak |
| Patients may benefit from self-management support | I | Strong |
| Patients may benefit from support groups and other community services | III-2 | Weak |
| Implement a COPD action plan to reduce risks associated with exacerbations, such as emergency department visits and hospital admissions | I | Strong |
SoR = Strength of recommendation according to the GRADE system (Andrews 2013, Guyatt 2008)
Key Recommendations for X: Manage eXacerbations | LoE | SoR |
|---|---|---|
| Diagnose a COPD exacerbation based on changes in the patient’s baseline dyspnoea, cough, and/or sputum that exceed normal day-to-day variations, are acute in onset, and may warrant a change in regular medication or hospital admission | III-2 | Strong |
| Diagnosing and treating exacerbations early may prevent hospital admission and delay COPD progression | III-2 | Strong |
| Initiate inhaled short-acting bronchodilators as a first-line treatment of exacerbations | I | Strong |
| Consider prescribing systemic corticosteroids to reduce the severity of and shorten recovery from exacerbations (oral route, when possible; 30 to 50mg daily for 5 days) | I | Strong |
| Consider prescribing antibiotic therapy (amoxycillin or doxycycline for 5 days) for COPD exacerbations with clinical features of infection (increased volume and change in colour of sputum and/or fever) | I | Strong |
| Use supplemental oxygen for hypoxaemia in COPD exacerbations, target SpO₂ 88% to 92% to improve survival | II | Strong |
| Controlled oxygen delivery (0.5 to 2.0 L/min) is indicated for hypoxaemia in patients with exacerbations. | II | Strong |
| Non-invasive ventilation improves survival for people with COPD and acute hypercapnic respiratory failure | I | Strong |
| Refer to pulmonary rehabilitation, particularly during the recovery phase following an exacerbation | I | Strong |
| The primary healthcare team should ensure that patients with COPD receive comprehensive follow-up care, after they are discharged from hospital following an exacerbation | I | Strong |
| Coordinate multidisciplinary support to help treat COPD exacerbations for patients in the community setting receiving home management | I | Weak |
SoR = Strength of recommendation according to the GRADE system (Andrews 2013, Guyatt 2008)
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