Chronic Obstructive Pulmonary Disease

Objectives

1. In all patients presenting with symptoms of prolonged or recurrent cough, dyspnea, or decreased exercise tolerance, especially those who also have a significant smoking history, suspect the diagnosis of chronic obstructive pulmonary disease (COPD).
2. When the diagnosis of COPD is suspected, seek confirmation with pulmonary function studies (e.g., FEV1).
3. In patients with COPD, use pulmonary function tests periodically to document disease progression.
4. Encourage smoking cessation in all patients diagnosed with COPD.
5. Offer appropriate vaccinations to patients diagnosed with COPD (e.g., influenza/pneumococcal vaccination).
6. In an apparently stable patient with COPD, offer appropriate inhaled medication for treatment (e.g., anticholinergics/bronchodilators if condition is reversible, steroid trial).
7. Refer appropriate patients with COPD to other health professionals (e.g., a respiratory technician or pulmonary rehabilitation personnel) to enhance quality of life.
8. When treating patients with acute exacerbations of COPD, rule out co-morbidities (e.g., myocardial infarction, congestive heart failure, systemic infections, anemia).
9. In patients with end-stage COPD, especially those who are currently stable, discuss, document, and periodically re-evaluate wishes about aggressive treatment interventions.