The origins of the COPD-X guidelines
These guidelines are the outcome of a joint project of the Thoracic Society of Australia and New Zealand and Lung Foundation Australia. The guidelines aim to:
- effect changes in clinical practice based on sound evidence; and
- shift the emphasis from a predominant reliance on pharmacological treatment of COPD to a range of interventions which include patient education, self-management of exacerbations and pulmonary rehabilitation.
These guidelines deal mainly with the management of established disease and exacerbations. However, this is only one element of the COPD Strategy of Lung Foundation Australia, which has the long-term goals of:
- primary prevention of smoking;
- improving rates of smoking cessation;
- early detection of airflow limitation in smokers before disablement; and
- improved management of stable disease and prevention of exacerbations.
In May 2001 a multidisciplinary steering committee was convened by the Thoracic Society of Australia and New Zealand (TSANZ) and The Australian Lung Foundation in accordance with the National Health and Medical Research Council recommendations for guideline development (National Health and Medical Research Council 1998). The Committee agreed to use the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop Report (NHLBI/WHO Workshop Report April 2001) as the prime evidence base, together with systematic reviews and meta-analyses from the Cochrane Database. The GOLD Report, released in April 2001, was produced by an international panel of experts in collaboration with the United States National Heart, Lung, and Blood Institute (NHLBI) and the World Health Organization (WHO). The levels of evidence in the current guidelines were assigned according to the system developed by the NHLBI (Box 1). Any changes to the guidelines have been based on subsequent versions of the GOLD report and on the results of systematic reviews or consistent evidence from well conducted randomised controlled trials.
The Guidelines Steering Committee supervised the development of specific items such as the COPDX Plan and a management handbook for primary care clinicians. Drafts of these documents were widely circulated to key stakeholder groups and professional organisations. In addition, the draft guidelines were published on the Internet http://www.lungnet.com.au (now http://www.lungfoundation.com.au) and access to them was advertised in a national newspaper. The draft guidelines were circulated to all members of the TSANZ and Australian Divisions of General Practice. All comments received were reviewed by the Steering Committee. The Guidelines were then published as a supplement to The Medical Journal of Australia in March 2003.
The Steering Committee then resolved to establish a COPD Guidelines Implementation Committee and a Guidelines Evaluation Committee. The terms of reference of the Evaluation Committee included scientific assessment of the impact of the guidelines on clinical practice and rigorous examination of the relevant medical literature to ensure the guidelines remain up to date. Any suggested modifications were circulated to members of the COPD Coordinating Committee and other key stakeholders prior to ratification. Following this, the guidelines were submitted to the COPD Special Interest Group of the Thoracic Society of Australia and New Zealand for endorsement.
Associate Professor David K McKenzie and Professor Peter Frith.
Principal authors and members of the COPD Implementation Committee.
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