Guidelines for the management of chronic obstructive pulmonary disease

Abstract

Objective. This guideline has been developed in order to optimise the management of patients with chronic obstructive pulmonasy disease (COPD) at all levels of the health care system in South Africa. It contains an action plan for early recognition and appropriate treatment of this common condition. Options. Treatment regimens are recommended for patients with mild (stage I), moderate (stage II) and severe (stage III) disease. Outcomes. Optimal management of patients with COPD may achieve a reduction in breathlessness, improved quality of life, prevention of complications and limitation of disease progression. Enidence. The Working Group comprised mainly pulmonologists, but included an anaesthetist, a pharmacologist and a physiotherapist. Detailed literature review with particular attention to similar guideline documents from Europe and the USA was performed before the meeting. Recommendations. Steps in the management of patients with COPD include early recognition of the disease, smoking cessation, treatment of airflow obstruction with appropriate drugs (singly or in combination), education and pulmonary rehabilitation, and limitation of disease progression and complications. Detailed recommendations are made with regard to the use and interpretation of a trial of oral corticosteroid therapy. Indications for hospitalisation, intensive care unit admission and ventilatory support are provided. Validation. This guideline is similar to those recommended by other groups outside South Africa. It was developed by a working group of the South African Pulmonology Society and is endorsed by the Medical Association of South Africa. Sponsors. The meeting of the Working Group was sponsored by Boehringer Ingelheim. This sponsorship did not influence the activities of the Group.