Abstract
Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is preventable and treatable but unfortunately remains underdiagnosed. The purpose of the present article from the Canadian Thoracic Society is to provide up-to-date information so that patients with this condition receive optimal care that is firmly based on scientific evidence. Important summary messages for clinicians are derived from the more detailed Update publication and are highlighted throughout the document. Three key messages contained in the update are: use targeted screening spirometry to establish a diagnosis and initiate prompt management (including smoking cessation) of mild COPD; improve dyspnea and activity limitation in stable COPD using new evidence-based treatment algorithms; and understand the importance of preventing and managing acute exacerbations, particularly in moderate to severe disease.
Highlights
DE O’Donnell, P Hernandez, A Kaplan, et al Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2008 update – highlights for primary care
Chronic obstructive pulmonary disease (COPD) management decisions should be made on an individual basis and should not be based exclusively on spirometry results and on an assessment of severity of dyspnea and disability, which are assessed by using the Medical Research Council dyspnea scale (Tables 1 and 2)
Arterial blood gas measurements should be considered in patients with forced expiratory volume in 1 s (FEV1) of less than 40% predicted to assess for evidence of hypoxemia or hypercapnia
Summary
O’Donnell et al DEFINITION AND PATHOPHYSIOLOGY Chronic obstructive pulmonary disease (COPD) is a respiratory disorder largely caused by smoking, and is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations. Women have a higher prevalence of COPD than men in all age groups except for the 75 years and older group. CLINICAL ASSESSMENT Most individuals with COPD are not diagnosed until the disease is well advanced. COPD management decisions should be made on an individual basis and should not be based exclusively on spirometry results and on an assessment of severity of dyspnea and disability, which are assessed by using the Medical Research Council dyspnea scale (Tables 1 and 2). Clinical differences between asthma and COPD can usually help in making a correct diagnosis (Table 3). Patients with a large improvement in FEV1 (eg, greater than 0.4 L) acutely following inhaled short-acting bronchodilators or following treatment with inhaled or oral steroids likely have an asthmatic component
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