COPD‐X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update

Abstract

Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD-X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au. Main recommendations: Spirometry detects persistent airflow limitation (post-bronchodilator FEV1/FVC < 0.7) and must be used to confirm the diagnosis.Non-pharmacological and pharmacological therapies should be considered as they optimise function (ie, improve symptoms and quality of life) and prevent deterioration (ie, prevent exacerbations and reduce decline).Pulmonary rehabilitation and regular exercise are highly beneficial and should be provided to all symptomatic COPD patients.Short- and long-acting inhaled bronchodilators and, in more severe disease, anti-inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self-management.Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.Comorbidities of COPD require identification and appropriate management.Supportive, palliative and end-of-life care are beneficial for patients with advanced disease.Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence-based management of COPD. Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non-pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.

Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices

“…Patients with chronic respiratory diseases, such as COPD or pulmonary fibrosis, experience a complex and often unpredictable disease course,4 which is characterised by a gradual decline, interrupted by sudden and life-threatening exacerbations 5 6. As the disease progresses, complications may become more frequent and complex 7. Disease progression may also lead to a variety of symptoms, such as dyspnoea, and comorbidities, which can reduce the quality of life of patients substantially 7…”

“…Patients, their relatives and healthcare professionals (HCPs) are faced with treatment decisions throughout the disease course. Acute deterioration of health can,7 for instance, result in respiratory failure requiring mechanical ventilation and the necessity of having to make ad hoc decisions on how to proceed 8…”

A review of the availability and cost effectiveness of chronic obstructive pulmonary disease (COPD) management interventions in rural Australia and New Zealand

“…The authors included studies that reported on interventions specifically targeting people with COPD living in rural or remote locations in Australia or New Zealand. These countries share a common guideline for the management of COPD, specified by the Thoracic Society of Australia and New Zealand 15 , which means interventions in the review were more likely to fall within the COPDX guidelines and be relevant to the investigators' practice. While reviewing only literature based in rural or remote areas substantially limited the scope of the review, it was recognised that the context of rural health is geographically, sociologically and demographically different to metropolitan settings 18 .…”

“…It has highlighted a need to review the key success factors for COPD management interventions internationally and in urban Australia and New Zealand and determine the transferability of intervention design to rural areas. 15 showing the process of study selection in a systematic review of the availability and cost effectiveness of chronic obstructive pulmonary disease management interventions in rural Australia and New Zealand. The authors included studies that reported on interventions specifically targeting people with COPD living in rural or remote locations in Australia or New Zealand.…”

Get with the guidelines: management of chronic obstructive pulmonary disease in emergency departments in Europe and Australasia is sub‐optimal

“…3,4 We assumed that patients attending an ED for care had at least a moderate exacerbation of COPD. Published COPD guidelines were used as the reference standard for treatment.…”