Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline from the American College of Physicians

Qaseem, Amir; Snow, Vincenza; Shekelle, Paul G; Sherif, Katherine; Wilt, Timothy J; Weinberger, Steven E.; Owens, Douglas K

doi:10.7326/0003-4819-147-9-200711060-00008

Cited by 396 publications

(428 citation statements)

References 48 publications

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“…This observation differed from that of a previous study involving general subjects in Japan who showed a similarly high prevalence of COPD (20). However, it could not be concluded from the present data whether spirometry should be performed to diagnose airflow obstruction in patients with exertional dyspnea (21), because the prevalence of subjects who complained of dyspnea was high throughout the 4 years of study I as well as in the 1-day screening used in study II. The present study suggests that advanced screening using a questionnaire system could be more effective than spirometry for COPD screening.…”

Section: Discussioncontrasting

confidence: 99%

Concerns with the Health Check-up System for Chronic Obstructive Pulmonary Disease on two Japanese Islands

et al. 2011

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Objective Early diagnosis is a key factor in the management of chronic obstructive pulmonary disease (COPD). Although mass screening is widely used, little is known about its accuracy and efficacy. This study investigated whether using spirometry during mass screening to detect COPD among community residents might be ineffective because of variability in the training and experience of examiners. Participants and Methods Both spirometry and a self-written questionnaire-based survey, including questions designed to detect respiratory symptoms, were conducted on community residents. Two separate studies were conducted on islanders living in similar environments. Study I was performed from 2004 to 2007 on Hachijyo Island residents, while study II, with a similar study design, was performed in 2003 on Inno Island residents. Results In study I, 3,592 subjects underwent examination over the 4-year study period; of these, 378 subjects underwent repeated examinations. Approximately 25% of the subjects had respiratory symptoms. Acceptable spirometry recordings were obtained for 62.0% (2004) to 84.1% (2006) of the subjects. In study II, 167 of the 254 subjects (65.7%) had respiratory symptoms. Acceptable assessment recordings were achieved in 254 subjects (95.5%). The suitability of the recordings was influenced by the extent/level of training of the examiners and the accompanying thoracic specialists. Conclusion We concluded that the effectiveness of health check-ups for COPD evaluation using spirometry was greatly influenced by the quality of the examiners, even when the subjects had respiratory symptoms. Thus, we recommend caution when screening for early signs of COPD during health check-ups.

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Section: Discussioncontrasting

confidence: 99%

Concerns with the Health Check-up System for Chronic Obstructive Pulmonary Disease on two Japanese Islands

et al. 2011

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“…As none of the control subjects in this study had respiratory problems or lung diseases or were receiving inhaled bronchodilators or corticosteroids, spirometry in this group was not conducted, in accordance with the guidelines of the American College of Physicians, American College of Chest Physicians, ATS, and ERS. 34 All subjects with COPD were stable, and 77% were non-admitted out-patient cases visiting the hospital for routine checkups and free medicines. The remaining 23% of subjects with COPD were admitted to the Cardio-Thoracic Centre for other causes.…”

Section: Resultsmentioning

confidence: 99%

Diagnostic Utility of Biomarkers in COPD

Ambade¹,

Sontakke

Barthwal³

et al. 2015

Respir Care

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BACKGROUND: COPD will become the third leading cause of death by 2020. There are many situations in which spirometry, the primary tool for diagnosis of COPD, cannot be performed, and thus, the staging and status of these patients cannot be determined. To date, there is no known biochemical marker used for diagnosing COPD. This study aimed to explore the utility of biomarkers for diagnosis of COPD. METHODS: This was an observational study composed of 96 stable subjects with COPD and 96 subjects with normal lung function. Each group contained an equal number of smokers and nonsmokers. Serum levels of superoxide dismutase 3, glutathione peroxidase, catalase, ceruloplasmin ferroxidase activity, C-reactive protein, and surfactant protein D (SPD) were estimated. Ferroxidase activity was estimated by a kinetic method, whereas the other analytes were measured by enzyme-linked immunosorbent assay. The cutoff value, sensitivity and specificity at the cutoff value, and area under the curve for each analyte were determined from receiver operating characteristic curve. RESULTS: Significantly decreased superoxide dismutase 3 and increased ferroxidase activity, SPD, glutathione peroxidase, and C-reactive protein levels were found in subjects with COPD. For all subjects and nonsmoking subjects with COPD, the area under the curve was highest for ferroxidase activity, followed by glutathione peroxidase, SPD, and C-reactive protein, with a sensitivity and specificity of > 73%. For smoking subjects with COPD, the area under the curve was highest for SPD, followed by glutathione peroxidase, ferroxidase activity, and C-reactive protein, with a sensitivity and specificity > 67%. Some combinations of markers were found to give either a sensitivity or specificity of > 95%, which can be utilized to rule in and rule out COPD. CONCLUSIONS: Biomarkers can be reliably utilized in the diagnosis of COPD. Of all the markers, SPD appears to be the most promising in smokers, whereas ferroxidase activity shows promise in nonsmokers. To rule out COPD, ferroxidase activity or glutathione peroxidase can be potentially useful, whereas to rule in COPD, ferroxidase activity and glutathione peroxidase appear to be the most promising combination in both nonsmoking and smoking subjects.

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“…However, with respect to mucolytics and airway clearance, dornase alfa is not recommended for patients with non-CF bronchiectasis. 15,16 Trials with clinically important outcome measures are needed to establish the evidence for mucoactive medications outside of CF. 17…”

Section: Hospitalized Adult and Pediatric Patients Without Cystic Fibmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2015

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Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or resolves atelectasis/consolidation compared with usual care. Recombinant human dornase alfa should not be used in hospitalized adult and pediatric patients without cystic fibrosis. The routine use of bronchodilators to aid in secretion clearance is not recommended. The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended. Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough. Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in these populations.

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Diagnosis and Management of Stable Chronic Obstructive Pulmonary Disease: A Clinical Practice Guideline from the American College of Physicians

Cited by 396 publications

References 48 publications

Concerns with the Health Check-up System for Chronic Obstructive Pulmonary Disease on two Japanese Islands

Concerns with the Health Check-up System for Chronic Obstructive Pulmonary Disease on two Japanese Islands

Diagnostic Utility of Biomarkers in COPD

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

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