Canadian Thoracic Society COPD Guidelines: Summary of Highlights for Family Doctors

C hronic obstructive pulmonary disease (COPD) is a major cause of disability and death throughout the world.The main goal of this educational initiative of the Canadian Thoracic Society (CTS) is to optimize early diagnosis, prevention and management of COPD in Canada. EpidemiologyAffecting about 4% of Canadian adults, COPD is a major health and economic concern.In 1999, COPD was the fourth leading cause of death in men and the fifth in women.It is predicted that morbidity and mortality from COPD will escalate over the next 15 years, particularly in the aging female population.Key Message #1: COPD is a respiratory disorder largely caused by smoking that is characterized by progressive, partially reversible airway obstruction, systemic manifestations, and increasing frequency and severity of exacerbations.Systemic effects include peripheral muscle dysfunction, right heart failure, polycythemia, change in nutritional status and depression, and these together with respiratory impairment contribute to a poor quality of life.Key Message #2: Family physicians have a primary role in the management of COPD.As primary health care providers, family physicians are responsible and ideally suited to provide early identification and diagnosis of COPD, patient education, smoking cessation counselling, initiation of drug treatment, management of acute exacerbations, long term follow-up and supportive end-of-life care.Key Message #3: Objective demonstration of air flow obstruction by spirometry is essential for the diagnosis of COPD.A postbronchodila-tor forced expiratory volume in 1 s (FEV 1 ) of less than 80% of the predicted normal value and a ratio of FEV 1 to forced vital capacity of less than 0.70 are both required for COPD to be diagnosed.Key Message #4: Most patients with COPD are not diagnosed until the disease is well advanced.Spirometry targeted at individuals who are at risk for COPD can establish an early diagnosis.The following criteria are helpful to family physicians when deciding who to target in their practice to undergo spirometry testing to detect COPD: 1. Smokers or exsmokers 40 years of age and older 2. Individuals with persistent cough and sputum production 3. Individuals with frequent respiratory tract infections 4. Individuals with progressive activity-related shortness of breath EVALUATION OF THE COPD PATIENTThe patient's history should include number of pack-years of smoking, frequency and severity of exacerbations, and an assessment of dyspnea and disability. Key Message #5:The Medical Research Council dyspnea scale (Figure 1) is a functional scale that is useful to assess shortness of breath and disability, and can assist in the evaluation of disease severity (Table 1).Physical examination and chest x-rays are not usu-

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