Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease – 2007 Update

Abstract

Chronic obstructive pulmonary disease (COPD) is a major respiratory illness in Canada that is both preventable and treatable. Our understanding of the pathophysiology of this complex condition continues to grow and our ability to offer effective treatment to those who suffer from it has improved considerably. The purpose of the present educational initiative of the Canadian Thoracic Society (CTS) is to provide up to date information on new developments in the field so that patients with this condition will receive optimal care that is firmly based on scientific evidence. Since the previous CTS management recommendations were published in 2003, a wealth of new scientific information has become available. The implications of this new knowledge with respect to optimal clinical care have been carefully considered by the CTS Panel and the conclusions are presented in the current document. Highlights of this update include new epidemiological information on mortality and prevalence of COPD, which charts its emergence as a major health problem for women; a new section on common comorbidities in COPD; an increased emphasis on the meaningful benefits of combined pharmacological and nonpharmacological therapies; and a new discussion on the prevention of acute exacerbations. A revised stratification system for severity of airway obstruction is proposed, together with other suggestions on how best to clinically evaluate individual patients with this complex disease. The results of the largest randomized clinical trial ever undertaken in COPD have recently been published, enabling the Panel to make evidence-based recommendations on the role of modern pharmacotherapy. The Panel hopes that these new practice guidelines, which reflect a rigorous analysis of the recent literature, will assist caregivers in the diagnosis and management of this common condition.

CTS position statement: Pharmacotherapy in patients with COPD—An update

“…Since the last published CTS COPD Guidelines in 2007 and 2008, 1,2 key messages regarding disease management remain at the forefront: 1) Use spirometry in targeted populations for case finding of "early" and undiagnosed COPD for prompt intervention (including enhancing effectiveness of smoking cessation interventions); 2) Improve the treatment algorithms by incorporating accurate assessment of dyspnea and activity limitation and; 3) Use strategies to prevent and manage acute exacerbations, particularly in moderate to severe disease.…”

“…dyspnea), improving exercise tolerance, physical activity and health status are key goals of COPD management. 1,3 This section of the COPD position statement specifically addresses the use of pharmacological maintenance therapies and their impact on patient-related outcomes (PRO) in patients with stable COPD. The importance of effective non-pharmacological therapies that target these PRO in COPD have been discussed previously and reviewed elsewhere.…”

“…The importance of effective non-pharmacological therapies that target these PRO in COPD have been discussed previously and reviewed elsewhere. 1,3 Dyspnea, a subjective experience of unpleasant, discomfort with breathing, is a cardinal symptom of COPD. 1,3 Dyspnea is associated with decreased exercise intolerance, reduced health status and poor prognosis in COPD.…”

“…1,3 Dyspnea, a subjective experience of unpleasant, discomfort with breathing, is a cardinal symptom of COPD. 1,3 Dyspnea is associated with decreased exercise intolerance, reduced health status and poor prognosis in COPD. Pathophysiological mechanisms for dyspnea and exercise intolerance in COPD have been well described elsewhere.…”

“…Since the last published Canadian Thoracic Society (CTS) COPD guideline in 2007 1 and the 2008 update -highlights for primary care, 2 many new clinical trials have challenged COPD treatment practices. Identifying important new evidence and assessing whether these findings warrant change in current practice is needed.…”