MONDAY, Aug. 1 (HealthDay News) -- Four of the world's leading
pulmonary associations have issued new guidelines for the diagnosis
and treatment of chronic obstructive pulmonary disease, one of the
world's leading killers.
While the recommendations are based on more recent studies of
the disorder, they differ little from previous guidelines and are
meant largely to emphasize how critical it is to manage the disease
to reduce hospitalizations, exacerbations and deaths, said lead
author Dr. Amir Qaseem, director of clinical policy in the medical
education division of the American College of Physicians, one of
the four sponsoring organizations.
"We're repeating the message. Chronic obstructive pulmonary disease is the third leading cause of death and . . . the number keeps going up. In 2007, it was the fifth leading cause of death," said Qaseem. "Many patients are still not getting the appropriate care."
The main advice of pulmonologists worldwide is not surprising:
quit smoking, especially if you've already been diagnosed with
chronic obstructive pulmonary disease (COPD). Smoking is the
leading risk factor for COPD.
"Smoking cessation remains key," said Dr. Sandhya Khurana, an assistant professor of medicine in the pulmonary and critical care division at the University of Rochester Medical Center in New York.
And lung damage, once it occurs, is irreversible, said Khurana,
who was not involved with the study that appears in the Aug. 2
issue of the
Annals of Internal Medicine.
COPD is caused by inflammation and constriction of the air
passages. Symptoms include trouble breathing, shortness of breath
with physical activity, chronic cough and wheezing.
The authors recommended that spirometry should only be used to
diagnose COPD in patients who already have symptoms. Spirometry is
a pulmonary function test which measures how much air a person
expels while exhaling (a measure called FEV1). "Spirometry is not
beneficial in patients who do not have respiratory symptoms even if
they have risk factors," Qaseem said.
Patients with COPD who don't have symptoms shouldn't be treated
as no real benefit has been shown.
Patients whose FEV1 is less than 60 percent and who also have
symptoms can get better outcomes with inhaled beta-agonists,
anticholinergics and corticosteroids.
These same drugs may benefit patients with an FEV1 of 60 percent
to 80 percent, though the evidence here is not as strong.
When FEV1 drops below 50 percent, patients with symptoms may
benefit from pulmonary rehabilitation.
And for patients who have severe shortness of breath, doctors
should prescribe oxygen.
The American Lung Association has more on