1st February 2007
Finnish Medical Society Duodecim - Professional Association
Summary,

GUIDELINE OBJECTIVE(S)

Evidence-Based Medicine Guidelines collect, summarize, and update the core clinical knowledge essential in general practice. The guidelines also describe the scientific evidence underlying the given recommendations.

TARGET POPULATION

* Adults with chronic obstructive pulmonary disease (COPD)
* Adults requiring evaluation for possible chronic obstructive pulmonary disease

INTERVENTIONS AND PRACTICES CONSIDERED

Diagnosis

1. Physical examination and assessment of signs and symptoms
2. Spirometry in combination with active promotion of smoking cessation
3. Assessment of forced expiratory volume in one second/forced vital capacity (FEV1/FVC)
4. Test with a bronchodilating drug and subsequent assessment of response (as measured by spirometry and bronchodilator dose or peak expiratory flow [PEF] follow-up)
5. Evaluation of the effectiveness of anti-inflammatory treatment with a trial of steroids (oral prednisolone or inhaled steroid)
6. Assessment of diffusion capacity
7. Blood gas analysis
8. Chest radiograph

Treatment

1. Cessation of smoking
2. Drug therapy
* Bronchodilating medication (Inhaled short acting or long acting anticholinergic drug; inhaled beta-sympathomimetic; oral, long-acting theophylline)
* Anti-inflammatory medication
3. Nonpharmacologic measures to promote mucous excretion
4. Treatment of acute exacerbation (oxygen by nasal catheter or by venturi mask; noninvasive positive pressure ventilation; an inhaled sympathomimetic, possibly in combination with an inhaled ipratropium bromide, methyl prednisolone or oral corticosteroids
5. Treatment of acute infection with antimicrobials
6. Exercise
7. Vaccinations (influenza, pneumococcal)
8. Oxygen therapy at home

MAJOR OUTCOMES CONSIDERED

* Symptom relief
* Exercise capacity
* Lung function (as measured by spirometry)
* Morbidity and mortality
* Quality of life
* Frequency and severity of exacerbations