Key Recommendations of the COPD-X Guidelines
C: Case finding and confirm diagnosis | Evidence level | Strength of recommendation* |
|---|---|---|
| Smoking is the most important risk factor in COPD development. | I | Strong |
| Smoking cessation reduces mortality. | I | Strong |
| A thorough history and examination is the first step in COPD diagnosis. | III-2 | Strong |
| COPD is confirmed by the presence of persistent airflow limitation (post-bronchodilator FEV1/FVC <0.7). | III-2 | Strong |
| Diagnosis of COPD should be accompanied by regular assessment of severity. | III-2 | Strong |
| If FEV1 increases >400 mL following bronchodilator, consider asthma, or coexisting asthma and COPD. | III-2 | Strong |
| Further investigations may help a) confirm or exclude other conditions (either coexisting or with similar symptoms to COPD) and b) assess the severity of COPD. | III-2 | Strong |
| Referral to specialist respiratory services may be required | III-2 | Strong |
O: Optimise function | Evidence level | Strength of recommendation* |
|---|---|---|
| Assessment is the first step to optimising function. | III-2 | Strong |
| Optimise pharmacotherapy using a stepwise approach. | I | Strong |
| Adherence and inhaler technique need to be checked on a regular basis. | I | Strong |
| Non-pharmacological strategies (such as pulmonary rehabilitation and regular exercise) should be provided to all patients with COPD. | I | Strong |
| Comorbid conditions are common in patients with COPD. | III-2 | Strong |
| Palliative care - ideally from a multidisciplinary team which includes the primary care team - should be considered early, and should include symptom control and addressing psychosocial issues. | II | Weak |
| Pulmonary rehabilitation improves quality of life and exercise capacity and reduces COPD exacerbations. | I | Strong |
| Lung volume reduction (surgical and endobronchial) improves lung function, exercise capacity and quality of life. | I | Weak |
| Long term macrolide antibiotics may reduce exacerbations in people with moderate to severe COPD and frequent exacerbations. | I | Weak |
| Long term non-invasive ventilation should be considered in people with stable COPD and hypercapnia to reduce mortality. | I | Weak |
P: Prevent deterioration | Evidence level | Strength of recommendation* |
|---|---|---|
| Smoking cessation is the most important intervention to prevent worsening of COPD. | II | Strong |
| Preventing exacerbations has a key role in preventing deterioration. | III-2 | Strong |
| Vaccination reduces the risks associated with influenza and pneumococcal infection. | I | Strong |
| Mucolytics may benefit certain patients with COPD. | I | Strong |
| Long-term oxygen therapy has survival benefits for COPD patients with hypoxaemia. | I | Strong |
D: Develop a plan of care | Evidence level | Strength of recommendation* |
|---|---|---|
| Good chronic disease care anticipates the wide range of needs in patients with COPD. | I | Strong |
| Clinical support teams working with the primary healthcare team can help enhance quality of life and reduce disability for patients with COPD. | 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 |
| COPD exacerbation action plans reduce emergency department visits and hospital admissions. | I | Strong |
X: Manage eXacerbations | Evidence level | Strength of recommendation* |
|---|---|---|
| A COPD exacerbation is characterised by a change in the patient's baseline dyspnoea, cough, and/or sputum that is beyond normal day-to-day variations, is acute in onset, and may warrant a change in regular medication or hospital admission. | III-2 | Strong |
| Early diagnosis and treatment of exacerbations may prevent hospital admission and delay COPD progression. | III-2 | Strong |
| Multidisciplinary care may assist home management of some patients with an exacerbation. | I | Weak |
| Inhaled bronchodilators are effective for initial treatment of exacerbations. | I | Strong |
| Systemic corticosteroids reduce the severity of, and shorten recovery from exacerbations. | I | Strong |
| Exacerbations with clinical features of infection (increased volume and change in colour of sputum and/or fever) benefit from antibiotic therapy. | II | Strong |
| Controlled oxygen delivery (0.5-2.0 L/min) is indicated for hypoxaemia in patients with exacerbations. | II | Strong |
| When using supplemental oxygen for hypoxia in COPD exacerbations, target SpO2 88–92% improves survival. | II | Strong |
| Non-invasive ventilation (NIV) is effective for patients with rising PaCO2 levels. | I | Strong |
| Non-invasive ventilation improves survival for people with COPD and acute hypercapnic respiratory failure. | I | Strong |
| Consider pulmonary rehabilitation at any time, including during the recovery phase following an exacerbation. | I | Strong |
| Patients with COPD discharged from hospital following an exacerbation should receive comprehensive follow-up led by the primary healthcare team. | I | Strong |
*The GRADE system was used to grade the strength of recommendations (Andrews 2013, Guyatt 2008)
Key recommendations translated to practice
Education and training
World COPD Day 2020
In November 2020 Lung Foundation Australia held a World Chronic Obstructive Pulmonary Disease (COPD) Day Primary Care webinar.
This session celebrated the recent launch of the COPD-X Concise Guide (June 2020) with updates to clinical guidelines and practical strategies to COPD quality improvement activities.
- Slides relating to the COPD-X Concise Guide delivered by Prof Ian Yang and Assoc Prof Eli Dabscheck, Co-Chairs of the COPD Guidelines Committee.
- Full webinar recording with the guest panel of experts who will cover the latest evidence-based COPD-X clinical guidelines and provide practical tools and resources for COPD quality improvement activities in primary care settings.
The guest panel included:
- Dr Kerry Hancock (Facilitator) – Chair, RACGP Respiratory Medicine Specific Interest Network. Chair, Primary Care Advisory Committee, Lung Foundation Australia.
- Professor Ian Yang – Professor of Medicine, The University of Queensland Director of Thoracic Medicine, The Prince Charles Hospital. Co-Chair, COPD-X Guidelines Committee, Lung Foundation Australia
- Dr Eli Dabscheck – Respiratory and Sleep Physician, Alfred Hospital and Monash University.
Co-Chair, COPD-X Guidelines Committee, Lung Foundation Australia. - Katrina Otto – Principal, Train IT Medical.