Guidelines for COPD Management

Guidelines for managing stable chronic obstructive pulmonary disease, released by the American College of Physicians, appear in the current issue of Annals of Internal Medicine.
Based on a literature review published in the same issue, the guidelines recommend:
using spirometry to diagnose — but not to screen asymptomatic patients for — airflow obstruction;
reserving treatment for symptomatic patients with FEV1 below 60% predicted;
treating patients with inhaled monotherapy comprising long-acting beta-agonists, anticholinergics, or corticosteroids (combination therapy may be considered);
using oxygen therapy in patients with resting hypoxemia;
limiting use of pulmonary rehab to symptomatic patients with FEV1 under 50% predicted.
The literature reviewers note that although monotherapy reduces exacerbations, it does not reduce mortality rates. For its part, oxygen therapy, used for at least 15 hours daily, reduces mortality in patients with resting hypoxemia and FEV1 under 30% predicted.