Guideline for the management of chronic obstructive pulmonary disease--2011 update

• Published in: South African medical journal 2011-01, Vol.101 (1 Pt 2), p.63-73
• Main Authors: Abdool-Gaffar, M S, Ambaram, A, Ainslie, G M, Bolliger, C T, Feldman, C, Geffen, L, Irusen, E M, Joubert, J, Lalloo, U G, Mabaso, T T, Nyamande, K, O'Brien, J, Otto, W, Raine, R, Richards, G, Smith, C, Stickells, D, Venter, A, Visser, S, Wong, M
• Format: Article
• Language: English
• Subjects: Bronchodilator Agents - therapeutic use; Chronic Disease; Corticosteroids; Diagnosis; Drug therapy; Exercise; Glucocorticoids - therapeutic use; Guideline Adherence - standards; Health aspects; Health Promotion - organization & administration; Humans; Life Style; Lung diseases, Obstructive; Metered Dose Inhalers; Practice guidelines (Medicine); Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Prevention; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Disease, Chronic Obstructive - therapy; Quality of Life; Referral and Consultation - standards; Risk Factors; Severity of Illness Index; Smoking; Smoking Cessation - methods; Smoking Prevention; South Africa; Spirometry
• ISSN: 0256-9574

To revise the South African Guideline for the Management of Chronic Obstructive Pulmonary Disease (COPD) based on emerging research that has informed updated recommendations. (1) Smoking is the major cause of COPD, but exposure to biomass fuels and tuberculosis are important additional factors. (2) Spirometry is essential for the diagnosis and staging of COPD. (3) COPD is either undiagnosed or diagnosed too late, so limiting the benefit of therapeutic interventions; performing spirometry in at-risk individuals will help to establish an early diagnosis. (4) Oral corticosteroids are no longer recommended for maintenance treatment of COPD. (5) A therapeutic trial of oral corticosteroids to distinguish corticosteroid responders from non-responders is no longer recommended. (6) Primary and secondary prevention are the most cost-effective strategies in COPD. Smoking cessation as well as avoidance of other forms of pollution can prevent disease in susceptible individuals and ameliorate progression. Bronchodilators are the mainstay of pharmacotherapy, relieving dyspnoea and improving quality of life. (7) Inhaled corticosteroids are recommended in patients with frequent exacerbations and have a synergistic effect with bronchodilators in improving lung function, quality of life and exacerbation frequency. (8) Acute exacerbations of COPD significantly affect morbidity, health care units and mortality. (9) Antibiotics are only indicated for purulent exacerbations of chronic bronchitis. (10) COPD patients should be encouraged to engage in an active lifestyle and participate in rehabilitation programmes. Treatment recommendations are based on the following: annual updates of the Global Obstructive Lung Disease (GOLD), initiative, that provide an evidence-based comprehensive review of management; independent evaluation of the level of evidence in support of some of the new treatment trends; and consideration of factors that influence COPD management in South Africa, including lung co-morbidity and drug availability and cost. Holistic management utilising pharmacological and nonpharmacological options are put in perspective. Working groups of clinicians and clinical researchers following detailed literature review, particularly of studies performed in South Africa, and the GOLD guidelines. BENEFITS, HARMS AND COSTS. The guideline pays particular attention to cost-effectiveness in South Africa, and promotes the initial use of less costly options. It promotes smoking cessat