COPD

CME credit available from Harvard Medical School through August 2023.

Published Materials

This module summarizes the current understanding of COPD and presents evidence-based clinical guidelines for its diagnosis and management in the primary care setting.

Chronic obstructive pulmonary disease, or COPD, is the fourth-leading cause of death in the U.S. following cancer, heart disease, and accidental injury, and it is a significant global public health issue.¹ Older adults account for a growing proportion of patients with COPD.² Smoking is the most common cause of COPD in the U.S.. A close relationship between the amount of tobacco smoked and the rate of decline in FEV₁ make smoking cessation the most important intervention for preventing or delaying COPD.

Diagnose COPD with spirometry

Start treatment using daily symptoms and exacerbation history

The current Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of COPD focuses on symptoms (e.g., dyspnea) and the annual history of exacerbations to group patients with COPD and recommend management strategies.³

Initial management options based on GOLD guidelines

Escalating the treatment of COPD

Management of COPD

New to the 2020 GOLD guidelines are treatment escalation pathways depending on whether the patient has had an exacerbation or dyspnea is not improving or worsening. The algorithms are utilized by finding patient’s current treatment regimen to identify how to advance therapy.

Advancing treatment of dyspnea

Optimizing treatment for patients with exacerbations

Stopping the use of ICS in patients with COPD

With similarly effective combination treatment options available, and the increased risk of pneumonia, replacing or stopping ICS should occur in patients without frequent exacerbations or high eosinophils.

The gradual withdrawal of ICS does not trigger exacerbations based on findings in the WISDOM trial.⁶

See the comprehensive evidence document (link at the top of the page) for additional information about other interventions for COPD, such as oxygen therapy, immunizations, and pulmonary rehabilitation, and management of acute exacerbations.

Additional Resources for providers

Additional Resources for patients

Information current at time of publication, August 2020.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating clinician based on the individual patient’s clinical condition.

References

Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2018 on CDC WONDER Online Database. http://wonder.cdc.gov/ucd-icd10.html. Published 2020. Accessed May 12, 2020.
Khakban A, Sin DD, FitzGerald JM, et al. The Projected Epidemic of Chronic Obstructive Pulmonary Disease Hospitalizations over the Next 15 Years. A Population-based Perspective. Am J Respir Crit Care Med. 2017;195(3):287-291.
Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2020 report.
Stenton C. The MRC breathlessness scale. Occup Med (Lond). 2008;58(3):226-227.
Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648-654.
Magnussen H, Disse B, Rodriguez-Roisin R, et al. Withdrawal of inhaled glucocorticoids and exacerbations of COPD. N Engl J Med. 2014;371(14):1285-1294.