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

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)