First-ever patient care guidelines in prevention of acute exacerbations of COPD

"Previous guidelines primarily address the management of COPD exacerbations. The prevention of acute exacerbations has not been a major focus until recently," said Dr. Jean Bourbeau, Guideline Vice-Chair and CTS member. "These new guidelines fill in the gaps that previously existed for prevention of exacerbations. The guideline is also unique as it is entirely focused on the prevention of acute exacerbations of COPD, and the joint effort of CTS and CHEST brought together a team of multidisciplinary clinicians representing pulmonary medicine and rehabilitation."

The guidelines address old and new pharmacological and nonpharmacological therapies available for prevention of COPD exacerbations and address the void, which had previously existed in the management of the care of patients suffering from COPD.

"According to the CDC, in 2010, the US cost for COPD was projected to be approximately $49.9 billion, and a study in the journal Respiratory Medicine reported that hospitalizations due to exacerbations account for more than 50% of the cost of managing COPD in North America and Europe," said Dr. Gerard Criner, Guideline Chair, CHEST member, and Director of the Temple Lung Center. "COPD is the third-leading cause of death in the United States and the fourth-leading cause of death in Canada. Our work in preventing exacerbations will help to improve the quality of lives for the millions living with this chronic condition. We hope it will also ease the financial burden associated with COPD."

COPD Facts:

• COPD is a lung disease characterized by chronic obstruction of lung airflow that interferes with normal breathing and is not fully reversible (source: World Health Organization).
• People with COPD are likely to experience acute episodes called exacerbations, during which their symptoms become worse or persist for days or longer (source: Mayo Clinic).
• Current COPD guidelines state that prevention of exacerbations is possible; little guidance is provided to the clinician regarding current available therapies for prevention of COPD exacerbations. Acute Exacerbation of Chronic Obstructive Pulmonary Disease: American College of Chest Physicians and Canadian Thoracic Society Guideline was developed to fill the void in the management of COPD.
• COPD caused 8 million office visits, 1.5 million emergency department visits, 715,000 hospitalizations, and 133,965 deaths in the United States in 2009 (source: CDC).
• COPD is the fourth-leading cause of death in Canadian men and women and the third-leading cause in the United States; it claimed 133,965 US lives in 2009. However, approximately 24 million US adults have evidence of impaired lung function, indicating an underdiagnosis of COPD (sources: CDC; Confronting COPD in America, 2000; Public Health Agency of Canada).
• In 2010, US costs for COPD were projected to be approximately $49.9 billion, including $29.5 billion in direct health-care expenditures, $8.0 billion in indirect morbidity costs, and $12.4 billion in indirect mortality costs (source: CDC).
• Exacerbations account for most of the morbidity, mortality, and costs associated with COPD. COPD accounts for the highest rate of hospital admissions among major chronic illnesses in Canada (source: Canadian Institute of Health Information).
• When exacerbations result in hospitalization, they have similar mortality to acute coronary syndrome. Observational studies have reported 8% of patients dying in hospitals and one-in-four patients dying in the subsequent 6 months (sources: Circulation, Canadian Respiratory Journal).
• The economic burden associated with moderate and severe exacerbations in Canada has been estimated in the range of $646 million to $736 million per annum (source: Journal of Respiratory Medicine).