Approach to chronic obstructive pulmonary disease in primary care.
OBJECTIVE
To review the diagnosis, assessment of severity, and management of chronic obstructive pulmonary disease (COPD) and to address the systemic manifestations associated with COPD.


METHODS
PubMed was searched from January 2000 to December 2007 using the key words COPD, practice guidelines, randomized controlled trials, therapy, and health outcomes. The Canadian Thoracic Society guideline on management of COPD was carefully reviewed. The authors, who have extensive experience in care of patients with COPD, provided expert opinion.


RESULTS
Chronic obstructive pulmonary disease is a common systemic disease caused primarily by smoking. Spirometry is essential for diagnosis of COPD and should be integrated into primary care practice. Pharmacologic and nonpharmacologic therapy improves symptoms, capacity for exercise, and quality of life. Smoking cessation is the only intervention shown to slow disease progression. The systemic manifestations and comorbidity associated with COPD need to be identified and addressed to optimize health and quality of life.


CONCLUSIONS
An evidence-based approach to managing COPD along with a primary care chronic disease management model could improve quality of life for patients with COPD.
Todd
David C
DC
McMaster University in Hamilton, Ont.
McIvor
R Andrew
RA
Pugsley
Stewart O
SO
Cox
Gerard
G
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004417:Dyspnea / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents