Managing COPD: Incorporating guidelines into primary care practice

There are now 2 recent guidelines to help US practitioners determine the best treatment practices for chronic obstructive pulmonary disease (COPD): from the American Thoracic Society in conjunction with the European Respiratory Society, and from the Global Initiative for Chronic Obstructive Lung Disease. Based on the symptoms and stages of severity, the guidelines employ a stepwise approach to treatment. COPD is clearly best managed by a comprehensive strategy, first and foremost including smoking cessation and patient education. Bronchodilators (anticholinergics and beta agonists) are the mainstay of COPD pharmacotherapy, and long-acting versions are preferred for long-term maintenance treatment. The effects of bronchodilators are enhanced when different classes of drugs are combined and by the addition of inhaled corticosteroids. These drugs provide benefit to COPD patients not only in terms of lung function and dyspnea, but also exacerbation rates and quality of life. Pulmonary rehabilitation can be added to medications to achieve additional benefits. Most exacerbations can be managed as an outpatient by the patient (with appropriate education) in conjunction with the primary care team. Primary care practitioners play a leading role in the management of COPD at all stages of the disease. Even when patients require referral for more specialized therapies, primary care physicians may remain the “team captain.” A collaborative provider-patient relationship is important to achieve optimal health outcomes in this chronic disorder. (Adv Stud Med. 2004;4(10A):S756-S766)