Canadian Thoracic Society releases new guidelines for treatment of COPD

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The Canadian Thoracic Society (CTS) recently released its new guidelines for the treatment of chronic obstructive pulmonary disease (COPD). The Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2007 are based upon the latest evidence and provide physicians with the most up-to-date information for treating this debilitating disease.

COPD is a progressive lung disease which includes chronic bronchitis and emphysema. More than 714,000 Canadians have been diagnosed with COPD and there are estimated to be thousands more who have not yet been diagnosed. In 2007 alone, approximately 9,000 Canadians will die from COPD and the incidence of the disease is steadily increasing. It is predicted that by 2020 COPD will be the third leading cause of death worldwide.

Recently, the number and size of randomized clinical trials in the area of COPD have increased dramatically. Major studies like TORCH and OPTIMAL have provided a wealth of new evidence on which to base these treatment recommendations and reinforce that COPD is a treatable, preventable and under-diagnosed disease.

Two of the most significant areas addressed by the 2007 guidelines are the prevention and management of exacerbations and new algorithms to ensure patients are receiving adequate therapy appropriate to their disease severity.

Exacerbations or worsening of symptoms can be triggered by simple occurrences such as a common cold, change in weather, or allergies. They can often result in visits to the local emergency department, hospitalization and, in severe cases, even death.

It’s imperative that physicians recognize the importance of exacerbations in the life of a patient with COPD. COPD is not just a nuisance disease that people live with, but a serious disease that people die from. Exacerbations in COPD patients should be considered as important as myocardial infarction in people with ischemic heart disease. Physicians need to not only prevent the first exacerbation, but work more proactively to prevent all subsequent flare ups of the disease.

New treatment algorithms outline optimal pharmacological and non-pharmacological management for COPD according to disease severity. With appropriate treatment, patients with COPD should expect to experience less shortness of breath, better exercise tolerance, fewer hospitalizations and improved quality of life.

Other key areas addressed in the 2007 guidelines include new information regarding the epidemiology of COPD based on the Burden of COPD in Canada survey; the link between COPD and co-morbidities; classification of disease severity; and regional disparity in access to pulmonary rehabilitation programs, patient education and coverage for medications.

The 2007 guidelines emphasize the importance of spirometry as not just a diagnostic tool for COPD, but to determine which patients will benefit most from specific pharmacological interventions.

The important take-away message for physicians from the revised guidelines is that this is a treatable disease, and with the right treatment options available, patients can do better. Through early diagnosis and correct assessment of disease severity through spirometry testing, along with prompt and aggressive treatment with both lifestyle changes and medications, COPD can be managed and patients can maintain an improved quality of life.

The revised COPD guidelines can be found at www.copdguidelines.ca. Additional respiratory guidelines produced by the CTS can be found at www.lung.ca/cts-sct under Guidelines and Standards.