Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2007 Update

Abstract

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is both preventable and treatable. Our understanding of the pathophysiology of this complex condition continues to grow and our ability to offer effective treatment to those who suffer from it has improved considerably. The purpose of the present educational initiative of the Canadian Thoracic Society (CTS) is to provide up to date information on new developments in the field so that patients with this condition will receive optimal care that is firmly based on scientific evidence. Since the previous CTS management recommendations were published in 2003, a wealth of new scientific information has become available. The implications of this new knowledge with respect to optimal clinical care have been carefully considered by the CTS Panel and the conclusions are presented in the current document. Highlights of this update include new epidemiological information on mortality and prevalence of COPD, which charts its emergence as a major health problem for women; a new section on common comorbidities in COPD; an increased emphasis on the meaningful benefits of combined pharmacological and nonpharmacological therapies; and a new discussion on the prevention of acute exacerbations. A revised stratification system for severity of airway obstruction is proposed, together with other suggestions on how best to clinically evaluate individual patients with this complex disease. The results of the largest randomized clinical trial ever undertaken in COPD have recently been published, enabling the Panel to make evidence-based recommendations on the role of modern pharmacotherapy. The Panel hopes that these new practice guidelines, which reflect a rigorous analysis of the recent literature, will assist caregivers in the diagnosis and management of this common condition.

Chronic obstructive pulmonary disease pathways as a tool to improve appropriateness in Internal Medicine Departments

“…With regard to bronchodilator therapy, although there are no controlled studies, there is great consensus on the choice of shortacting bronchodilators, b2-agonist (SABA) and/or short acting muscarinic antagonists (SAMA). [9][10][11][12][13][14][15][16][17]22,23 The administration of short-acting bronchodilators must be of intensive type, every 5-6 h, because their duration of action, in particular for SABA, is only 4-6 h.…”

“…30,31,34 Recently have been recommended shorter cycles of systemic corticosteroid therapy (5 days) 9 compared to traditional 7-14 days. [11][12][13] The continuation of systemic steroid therapy beyond two weeks has not shown advantages on acute exacerbation.…”

Appropriateness of Triple Therapy after COPD Exacerbation

“…1 Our study 2 focused on severe COPD exacerbations leading to hospital admission, and the mean number of admissions for an acute exacerbation of COPD in the previous year was about one per patient.…”

Current situation of asthma-COPD overlap syndrome (ACOS) in Chinese patients older than 40 years with airflow limitation: rationale and design for a multicenter, cross-sectional trial (study protocol)

“…Few studies have been conducted to provide a fair understanding of ACOS manifested by both asthma and COPD symptoms (9,11,12). Studies from the western population have shown the prevalence of ACOS to be 1.8% when diagnosed using spirometry (13) and 2.7% when diagnosed based on self-reported or physician-diagnosed asthma and COPD (14). Furthermore, the prevalence of ACOS (3.2%) was lower than COPD (6.0%) or asthma alone (5.6%) in the United States (15), whereas the percentage of patients visiting emergency departments was high for ACOS than for COPD alone in Korea (16).…”