COPD: NEJM review update on diagnosis and treatment

  • Celli BR & al.
  • N Engl J Med
  • 26 Sep 2019

  • International Clinical Digest
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • A new review published in the New England Journal of Medicine (NEJM) updates clinicians on the clinical aspects of COPD by including a new algorithm for diagnosis and another for treatment, both based on the latest clinical research.

Why this matters

  • COPD is the third leading cause of mortality globally, with a death toll predicted to reach 4.4 million by 2040.

Highlights

  • COPD should be seen as a clinical syndrome, rather than a single entity, which features chronic respiratory symptoms, structural pulmonary abnormalities, lung function impairment, or any combination.
  • COPD is underdiagnosed, largely because it is viewed as a disease of the elderly.
  • COPD should be diagnosed and treated as early as possible because earlier interventions can stabilize lung function decline.
  • Diagnosis:
    • A new algorithm for diagnosis begins with family history and exposure to smoking or pollution, and includes monitoring with annual spirometry. Spirometry value of FEV1:FVC 1 ≤80% of predicted dictates whether to monitor with annual spirometry or to treat.
    • Coexisting conditions and multimorbidity include ischemic heart disease, atrial fibrillation, heart failure, osteoporosis, lung cancer, gastroesophageal reflux, anxiety, and depression.
  • Treatment:
    • A new treatment algorithm, which stratifies cases from mild to severe, includes blood eosinophil count 3 for adjustment of therapy.