Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2003

Abstract

Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society (CTS) Evidence-Based Guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and exsmokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilatory therapy. Inhaled steroids should not be used as first-line therapy in COPD but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Management strategies consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation/exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care.

Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD

“…During AECOPD, individuals experience incapacitating dyspnea caused by a severe increase in the work of breathing and may exhibit increased use of accessory muscles. These individuals may also experience alterations in their vital signs [55,56] .…”

“…Changes in the volume, color and viscosity of the sputum may also be present [56] . As the dyspnea worsens, individuals are less able to complete a full sentence and experience alterations in the level of consciousness.…”

“…Bronchodilators are used to relieve symptoms as they provide relief of bronchoconstriction. The ideal bronchodilator would be well tolerated by the patient, demonstrate sustained improvement in spirometry, exercise performance, dyspnea, and quality of life and a decrease in lung hyperinflation [56] . The use of a metered dose inhaler (MDI) with spacer device or a dry powder inhaler (DPI) is preferred over the use of a nebulizer for all patients regardless of age or level of severity.…”

Bronchodilator response in the lung health study over 11 yrs

“…Both imply that this occurred in COPD and that its prevalence increased with serial testing because of poor reproducibility [1]. More recent guidelines [3][4][5] either do not refer to bronchodilator response as a diagnostic criterion or state that it is not significant unless ''large'' [5]. However, recent clinical trials, particularly of inhaled steroids, have excluded patients with significant bronchodilator responses [6,7], presumably to lower the risk of unknowingly including patients with asthma or features of asthma.…”

Development of a Theory-Based Intervention to Increase Prescription of Inspiratory Muscle Training by Health Professionals in the Management of People with Chronic Obstructive Pulmonary Disease

“…The conflicting messages from the literature may have contributed to the confusion among physiotherapists with respect to this intervention (see Table 1). Furthermore, gaps between the evidence for effectiveness of IMT and prioritized therapies outlined in practice guidelines for COPD management [34][35][36] may be an additional barrier to physiotherapists' use of IMT in clinical practice (see Table 1). Another factor relates to the applicability of the research findings to a physiotherapist's patient population.…”