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.IStrong
A thorough history and examination is the first step in COPD diagnosis.III-2Strong
COPD is confirmed by the presence of persistent airflow limitation (post-bronchodilator FEV1/FVC <0.7).III-2Strong
Diagnosis of COPD should be accompanied by regular assessment of severity.III-2Strong
If FEV1 increases >400 mL following bronchodilator, consider asthma, or coexisting asthma and COPD.III-2Strong
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-2Strong
Referral to specialist respiratory services may be requiredIII-2Strong

O: Optimise function


Evidence level


Strength of recommendation*


Assessment is the first step to optimising function.III-2Strong
Optimise pharmacotherapy using a stepwise approach.IStrong
Adherence and inhaler technique need to be checked on a regular basis.IStrong
Non-pharmacological strategies (such as pulmonary rehabilitation and regular exercise) should be provided to all patients with COPD.IStrong
Comorbid conditions are common in patients with COPD.III-2Strong
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 issuesIIWeak

P: Prevent deterioration


Evidence level


Strength of recommendation*


Smoking cessation is the most important intervention to prevent worsening of COPD.IIStrong
Preventing exacerbations has a key role in preventing deterioration.III-2Strong
Vaccination reduces the risks associated with influenza and pneumococcal infection.IStrong
Mucolytics may benefit certain patients with COPD.IStrong
Long-term oxygen therapy has survival benefits for COPD patients with hypoxaemia.IStrong

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.IStrong
Clinical support teams working with the primary healthcare team can help enhance quality of life and reduce disability for patients with COPD.III-2Weak
Patients may benefit from self-management support.IStrong
Patients may benefit from support groups and other community services.III-2Weak

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-2Strong
Early diagnosis and treatment of exacerbations may prevent hospital admission and delay COPD progression.III-2Strong
Multidisciplinary care may assist home management of some patients with an exacerbation.IWeak
Inhaled bronchodilators are effective for initial treatment of exacerbations.IStrong
Systemic corticosteroids reduce the severity of, and shorten recovery from exacerbations.IStrong
Exacerbations with clinical features of infection (increased volume and change in colour of sputum and/or fever) benefit from antibiotic therapy.IIStrong
Controlled oxygen delivery (0.5-2.0 L/min) is indicated for hypoxaemia in patients with exacerbations.IIStrong
Non-invasive ventilation (NIV) is effective for patients with rising PaCO2 levels.IStrong
Consider pulmonary rehabilitation at any time, including during the recovery phase following an exacerbation.IStrong
Patients with COPD discharged from hospital following an exacerbation should receive comprehensive follow-up led by the primary healthcare team.IStrong

*The GRADE system was used to grade the strength of recommendations (Andrews 2013, Guyatt 2008)