International Primary Care Respiratory Group (IPCRG) Guidelines: Management of Chronic Obstructive Pulmonary Disease (COPD)

Abstract

Summary COPD is a common and under-diagnosed disease which is increasing in prevalence worldwide. A more aggressive and optimistic approach must be adopted towards its management in primary care. This IPCRG Guideline on the management of COPD in primary care is fully consistent with GOLD guidelines. It highlights the goals of COPD treatment and the need for spirometric testing to make the diagnosis. It covers the classification of the disease according to disease severity, non-pharmacologic therapy including smoking cessation, avoidance of risk factors, patient education, pharmacologic therapy including the use of oxygen treatment, the management of exacerbations, the role of pulmonary rehabilitation, and the need for monitoring and ongoing care for COPD patients.

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

“…142 International and national guidelines focus attention on preventing COPD, case finding and/or screening to promote early diagnosis, proactive treatment of symptoms, and attention to supportive and end-of-life care needs. [143][144][145][146][147][148] Primary care physicians play a key role in all these aspects of COPD management.…”

“…27,154 Guidelines base the classification of severity on postbronchodilator spirometry, and recommend a threshold forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio less than 0.7 to confirm a diagnosis of COPD. [143][144][145][146][147][148] This fixed ratio cutoff has the advantage of simplicity but does not allow for the natural reduction in the ratio due to lung ageing, thus risking under-diagnosis in younger patients and over-diagnosis in the elderly. 35 The use of the lower limit of normal (LLN) may improve diagnostic precision but accurate reference ranges are needed in the older patients.…”

“…[143][144][145][146][147][148] Recent work suggests that the qualitative difference between 'bad days' and 'exacerbations' may be quantifiable, thus supporting the concept of 'COPD control' 166 though the significance of this in clinical practice has yet to be established. The BODE index, 167 while increasingly important in staging COPD in secondary care practice, involves measurements not routinely available in primary care.…”

“…143,[145][146][147][148] and the IPCRG guidelines for COPD management provide a primary care perspective. 144 Pragmatic primary care trials with minimum exclusion criteria are needed to assess effectiveness in the diverse populations and healthcare systems in which primary care operates globally.…”

“…Despite evidence-based recommendations on the management of acute exacerbations of COPD, [143][144][145][146][147][148] there are many unresolved questions for primary care clinicians about definition, prediction, early detection and accurate diagnosis of the cause of exacerbations with the limited diagnostic tools available in the community. 184,185 Although avoidance of costly admissions is a key policy objective in many healthcare systems, and community-based support may enable safe provision of 'hospital-at-home' care, 186 a core skill for primary care clinicians in any healthcare setting is recognition of when to refer for specialist care.…”