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Overview: Management of Stable COPD

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The full newsletter Management of Stable COPD, prescribing information and CME self-assessment are free for both AMA members and non-members.

Of the major noncommunicable diseases in the US, the only one with increasing mortality is chronic obstructive pulmonary disease (COPD). Health care costs of COPD management are high, with an estimated 2010 direct cost of $29 billion and indirect cost of $20 billion in the US. A recent study estimated the lifetime risk of being diagnosed with COPD at a strikingly high level of 27.6%, which was greater than congestive heart failure and common cancers. This issue of AMA Therapeutic Insights reviews the application of the GOLD (Global Initiative for Obstructive Lung Disease) guidelines to the management of COPD.

Instead of relying only on FEV1 to manage COPD, the 2011 updated GOLD guidelines recommends the use of lung function measurements in conjunction with an assessment of symptoms, the impact of COPD on their daily life, and the frequency of exacerbations to make decisions regarding initial and subsequent treatment. Initial treatment choices are based on a classification that combines assessment of disease severity and risk of exacerbations. This classification consists of four categories: Group A (Low risk, less symptoms), Group B (Low risk, more symptoms), Group C (High risk, less symptoms), and Group D (High risk, more symptoms).

Initial management of each group is as follows: Group A: a short-acting bronchodilator prn; Group B: a long-acting bronchodilator; Group C and D: long-acting anticholinergic or inhaled corticosteroid/long-acting beta-agonist combination.

In "Management of Stable COPD" physicians will learn to:

  • Apply the GOLD guidelines to patients with COPD
  • Utilize evidence-based treatment for COPD
  • The full newsletter contains national patient claims data which are analyzed to show the patterns of use of maintenance and rescue therapies for COPD including the use of long-acting bronchodilators (i.e., β-agonists and anticholinergics), short-acting anticholinergics and β-agonists, inhaled steroids, methylxanthines and combinations of these agents within 90 days of the patient claim.  The patterns of comorbid conditions in these patients are also presented.

    View the full newsletter Management of Stable COPD, and learn how to receive CME credit. Newsletters are available to all physicians, not just AMA members.