Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease--2003.
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.
O'Donnell
Denis E
DE
Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen's University, 102 Stuart Street, Kingston, Ontario K7L 2V6, Canada. odonnell@post.queensu.ca
Aaron
Shawn
S
Bourbeau
Jean
J
Hernandez
Paul
P
Marciniuk
Darcy
D
Balter
Meyer
M
Ford
Gordon
G
Gervais
Andre
A
Goldstein
Roger
R
Hodder
Rick
R
Maltais
Francois
F
Road
Jeremy
J
D002170:Canada / Q000453:epidemiology; D006801:Humans; D016040:Lung Transplantation; D010166:Palliative Care; D010353:Patient Education as Topic; D011013:Pneumonectomy; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012121:Respiration, Artificial; D019141:Respiratory System Agents / Q000627:therapeutic use; D019896:alpha 1-Antitrypsin Deficiency
D019141:Respiratory System Agents