Diagnosis and management of stable chronic obstructive pulmonary disease: a clinical practice guideline from the American College of Physicians.
RECOMMENDATION 1: In patients with respiratory symptoms, particularly dyspnea, spirometry should be performed to diagnose airflow obstruction. Spirometry should not be used to screen for airflow obstruction in asymptomatic individuals. (Grade: strong recommendation, moderate-quality evidence.) RECOMMENDATION 2: Treatment for stable chronic obstructive pulmonary disease (COPD) should be reserved for patients who have respiratory symptoms and FEV1 less than 60% predicted, as documented by spirometry. (Grade: strong recommendation, moderate-quality evidence.) RECOMMENDATION 3: Clinicians should prescribe 1 of the following maintenance monotherapies for symptomatic patients with COPD and FEV1 less than 60% predicted: long-acting inhaled beta-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids. (Grade: strong recommendation, high-quality evidence.) RECOMMENDATION 4: Clinicians may consider combination inhaled therapies for symptomatic patients with COPD and FEV1 less than 60% predicted. (Grade: weak recommendation, moderate-quality evidence.) RECOMMENDATION 5: Clinicians should prescribe oxygen therapy in patients with COPD and resting hypoxemia (Pao2 < or =55 mm Hg). (Grade: strong recommendation, moderate-quality evidence.) RECOMMENDATION 6: Clinicians should consider prescribing pulmonary rehabilitation in symptomatic individuals with COPD who have an FEV1 less than 50% predicted. (Grade: weak recommendation, moderate-quality evidence.).
Qaseem
Amir
A
American College of Physicians and Drexel University College of Medicine, Philadelphia, Pennsylvania 19106, USA. aqaseem@acponline.org
Snow
Vincenza
V
Shekelle
Paul
P
Sherif
Katherine
K
Wilt
Timothy J
TJ
Weinberger
Steven
S
Owens
Douglas K
DK
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D010102:Oxygen Inhalation Therapy; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D018343:Receptors, Adrenergic, beta-2 / Q000627:therapeutic use; D013147:Spirometry
D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018680:Cholinergic Antagonists; D018343:Receptors, Adrenergic, beta-2