(September 2007) The Canadian Thoracic Society (CTS) released new guidelines for the treatment of chronic obstructive pulmonary disease (COPD). The “Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease – 2007”1 are based upon the latest evidence and provide physicians with the most up-to-date information for treating this debilitating disease.

COPD is a progressive lung disease which includes chronic bronchitis and emphysema. More than 714,000 Canadians have been diagnosed with COPD and there are estimated to be thousands more who have not yet been diagnosed . In 2007 alone, approximately 9,000 Canadians will die from COPD and the incidence of the disease is steadily increasing. It is predicted that by 2020 COPD will be the third leading cause of death worldwide .

“Several large randomized clinical trails in the area of COPD have recently been reported,” says Dr. Justin Travers, a repirologist on PEI. “These major studies have provided us with a wealth of new evidence on which to base these treatment recommendations and reinforce that COPD is a treatable and preventable, yet under-diagnosed disease.”

Changes to the guidelines:

Two of the most significant areas addressed by the 2007 guidelines are the prevention and management of exacerbations and new algorithms to ensure patients are receiving adequate therapy appropriate to their disease severity.

Exacerbations or worsening of symptoms can be triggered by simple occurrences such as a common cold, change in weather, or allergies. They can often result in visits to the local Emergency Department, hospitalization and, in severe cases, can lead to death.

“It is vital that physicians recognize the importance of exacerbations in COPD patients in the same way as myocardial infarction in people with ischaemic heart disease,” says Dr. Travers. “We need to work more proactively to prevent these flare-ups of the disease.”

New treatment algorithms outline optimal pharmacological and non-pharmacological management for COPD according to disease severity. With appropriate treatment, patients with COPD should expect to experience less shortness of breath, better exercise tolerance, fewer hospitalizations and improved quality of life.

Other key areas addressed in the 2007 guidelines include:
o New information regarding the epidemiology of COPD based on the Burden of COPD in Canada survey.
o Rates of COPD prevalence have been underestimated and are continuing to increase, particularly among women. COPD is now the fourth leading cause of death in Canada.
o The link between COPD and co-morbidities.
o There is now evidence to associate COPD with co-morbid diseases, including CVD, cancer, osteoporosis, glaucoma, cataracts, depression and malnutrition.
o Classification of disease severity.
o The revised guidelines address the measurement of airflow through spirometry to be more aligned with international guidelines, while still recognizing the importance of symptoms as measures of functional disability.
o Regional disparity in access to pulmonary rehabilitation programs, patient education and coverage for medications.

Implications of 2007 guidelines for clinical practice:

The 2007 guidelines emphasize the importance of spirometry as not just a diagnostic tool for COPD, but to determine which patients will benefit most from specific pharmacological interventions.

“The important take-away message for physicians from the revised guidelines is that this is a treatable disease, and with the right treatment options available, patients can do better,” says Dr. Travers. “Through early diagnosis with spirometry testing, correct assessment of disease severity and early and aggressive treatment with both lifestyle changes and medications, COPD can be managed and patients can maintain an improved quality of life.”

The revised COPD guidelines can be found at www.copdguidelines.ca. Additional respiratory guidelines produced by the CTS can be found at www.lung.ca/cts-sct under Guidelines and Standards.

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Operating since 1936, The Lung Association is one of Prince Edward Island’s oldest and most respected health charities, and the leading national organization for science-based information, research, education, support programs and advocacy on lung heath issues. The mission of the PEI Lung Association is to be a recognized leader in the protection of clean air, the promotion of respiratory health, and the prevention of lung disease. The PEI Lung Association encourages all Islanders to call 1-888-566-5864 to learn the best strategies for a healthy home.

The Canadian Thoracic Society (CTS), founded in 1958, is the medical section of The Lung Association. The CTS promotes lung health by supporting the respiratory community through leadership, collaboration, research, learning and advocacy and by promoting the best respiratory practices in Canada. It also advises The Lung Association on scientific matters.

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Notes:
These guidelines were developed under the auspices of the Scientific Review Panel of the Canadian Thoracic Society. This process was facilitated by funding from ALTANA Pharma Inc, AstraZeneca Canada Inc, Bayer Canada Inc, Boehringer Ingelheim (Canada) Inc, Bristol-Myers Squibb, GlaxoSmithKline Inc and Pfizer. None of the pharmaceutical sponsors played a role in the collection, review, analysis or interpretation of the scientific data or in any decisions regarding recommendations.

Contacts:
Dr. Justin Travers
Respirologist
Tel: (902) 432-8181

Sheila Gaudet, Executive Director
PEI Lung Association
Tel: (902) 892-5957

By:Lisa Duffy

Thanks for the imformation!