Guidelines for Diagnosing and Treating COPD Updated

Updated guidelines on diagnosing and treating stable chronic obstructive pulmonary disease (COPD) have been released by the American College of Physicians and three respiratory societies in the Annals of Internal Medicine.

Among the changes since 2007:

• Inhaled bronchodilators may be used for symptomatic patients with an FEV1 between 60% and 80% of predicted values, in addition to those with an FEV1 below 60%.

• Clinicians should base the choice of monotherapy with long-acting inhaled anticholinergics or long-acting inhaled beta-agonists on cost, patient preference, and potential adverse effects.

• Symptomatic or exercise-limited patients with an FEV1 greater than 50% of predicted may be considered for pulmonary rehabilitation.

• Patients with severe hypoxemia at rest should receive continuous oxygen therapy.

The guidelines reaffirm that combination therapy may be used, but there is not enough evidence to recommend when it should be chosen over monotherapy.