ACP updates guideline on diagnosis and management of stable COPD.

www.aafp.org/afp Volume 85, Number 2 ◆ January 15, 2012 Chronic obstructive pulmonary disease (COPD) affects more than 5 percent of U.S adults and is the third leading cause of death. Manifestations of COPD range from dyspnea and poor exercise tolerance to chronic cough, wheezing, and respiratory failure. In cooperation with the American College of Chest Physicians, American Thoracic Society, and European Respiratory Society, the American College of Physicians (ACP) recently updated its 2007 guideline on the diagnosis and management of stable COPD to include new recommendations on when to consider pharmacotherapy, how to select an agent for monotherapy, and the preferred treatment for patients with respiratory symptoms and a forced expiratory volume in one second (FEV1) between 60 and 80 percent of predicted. The diagnosis of COPD is confirmed when a symptomatic patient is found to have airflow obstruction (generally defined as a postbronchodilator FEV1/forced vital capacity ratio of less than 0.70). The best combination of factors to exclude COPD is never having smoked, no patient-reported wheezing, and no wheezing on examination. Treatment benefits for COPD are primarily related to preventing and treating exacerbations among patients who have or are likely to have them, reducing hospitalizations and mortality, relieving dyspnea that limits activity, and improving exercise tolerance and health-related quality of life.