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 |
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 |
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 |
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 |
Non-invasive ventilation (NIV) is effective for patients with rising PaCO2 levels. | 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)
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