Primary care of the patient with chronic obstructive pulmonary disease-part 2: pharmacologic treatment across all stages of disease

Abstract

National guidelines for the pharmacologic treatment of chronic obstructive pulmonary disease (COPD) can be clarified for busy primary care practitioners who must deal with dozens of such treatment algorithms. MEDLINE searches and reviews of national evidence-based guidelines identified clinical trials and meta-analyses with relevant information on the stage-by-stage pharmacologic treatment of COPD. After formal presentations to a panel of pulmonary specialists and primary care physicians, key messages to assist in the implementation of guideline-based care in the primary care setting were identified and integrated into this article, the second in a 4-part mini-symposium. Main points of the roundtable consensus were as follows: (1) Spirometry is required for the diagnosis and staging of patients with COPD before treatment initiation; (2) all patients with COPD should be counseled to stop smoking, encouraged to start regular physical activity, and given a yearly influenza vaccination; (3) severity-based drug treatment of mild or moderate COPD, which accounts for 95% of all COPD cases, generally involves long-acting > or =1 bronchodilator because of their effectiveness and convenience; (4) patient response in terms of dyspnea, exercise ability, and side effects should be the primary guide for monitoring therapy; and (5) proper treatment of COPD can relieve patient symptoms, boost exercise capacity, reduce the number and severity of exacerbations, and improve the overall quality of life. We conclude that implementation of a relatively simple evidence-based treatment algorithm can be applied to that vast majority of the COPD population seen only in primary care.