Table 2: Recommendations by Professional Societies for Management of Stable COPD

Table 2:
*Recommendations by Professional Societies for Management of Stable COPD**
American Thoracic Society 1995	European Respiratory Society 1995	British Thoracic Society 1997	Global Initiative for Chronic Obstructive Lung Disease 2001
Consensus	Consensus	Consensus	Evidence-based Review
Diagnostic Testing
Recommended: Spirometry Pre- and post- BD Pre- and post- corticosteroid only if inadequate response to treatment	Recommended: Spirometry Pre- and post-BD Pre- and post- corticosteroid in stages 2 and 3	Recommended: Spirometry Pre- and post-BD Pre- and post- corticosteroid in stages 2 and 3	Recommended: Spirometry Pre- and post-BD Pre- and post- corticosteroid in stages 2 and 3
CXR	CXR	CXR in moderate or severe disease	CXR to exclude alternative DX
CT: not routinely, but helpful in predicting the benefit of pulmonary resection for giant bullous disease	CT assessment of bullae	Restricted to assessment of bullous emphysema	CT when DX is in doubt or if LVRS is contemplated
ABG in stages 2 or 3	ABG in stages 2 or 3 or Sao₂<92%	ABG in severe disease	ABG if FEV₁ is <40% or with symptoms suggestive of RHF or in respiratory failure
Alpha₁-AT deficiency in early, severe disease	Alpha1-AT deficiency in early, severe disease	Not discussed	Alpha₁-AT deficiency in early COPD (age < 45) or strong family history
Bronchodilator Therapy
Beta₂ agonist first line PRN use; anticholinergic first line for regular use; theophylline and/or sustained release albuterol for persistent symptoms	Beta₂ agonist or anticholinergic as needed; combination if needed; theophylline if no response to other BD; long-acting inhaled beta₂agonist or oral if needed	Short-acting beta₂ agonist or inhaled anticholinergic as needed; regular beta₂ agonist and/or anticholinergics and/or combination for advanced stages; long-acting beta₂ agonist if evidence of improvement; theophylline is of limited value	Short-acting BD as needed Regular treatment with one or more BD in advanced stages; long-acting inhaled BD more convenient; combination BD and anticholinergics is better than either agent alone
Corticosteroids
If corticosteroid response established: Lowest effective oral dose used Insufficient data to support use of aerosolized steroid	If corticosteroid response established: Inhaled steroids Inhaled steroids in patients with mild disease but "fast decline" of FEV₁ (> 50 ml per year)	If corticosteroid response established: Inhaled steroids	If corticosteroid response established: Inhaled steroids Inhaled steroids in stages 2 or 3 Long-term oral steroids not recommended
Antibiotics
Not recommended	Not recommended	Not recommended	Not recommended
Mucokinetics
Not recommended	Not recommended	Not recommended	Not recommended
Alpha₁- antitrypsin augmentation therapy
In appropriate patients	Not recommended	Not discussed	In appropriate patients
Vaccinations
Influenza recommended; pneumococcal recommended	Influenza recommended; pneumococcal, insufficient data	Influenza recommended; pneumococcal, insufficient data	Influenza recommended pneumococcal, insufficient data
Smoking Cessation
Recommended; smoking cessation protocol	Recommended	Recommended	Recommended
LVRS
In appropriately selected patients	In appropriately selected patients	In appropriately selected patients	Not recommended, insufficient data
Lung Transplantation
In appropriately selected patients	In appropriately selected patients	In appropriately selected patients	In appropriately selected patients
Home Mechanical Ventilation
Nonelective ventilation supported; elective ventilation not supported	No recommendation provided	Elective and nonelective ventilation modestly supported	Not supported
LTOT
Recommended in patients with chronic hypoxemia	Recommended in patients with chronic hypoxemia	Recommended in patients with chronic hypoxemia	Recommended in patients with chronic hypoxemia
Pulmonary Rehabilitation
Recommended; upper extremity training and breathing retraining supported	Recommended	Recommended	Recommended along with nutrition, counseling, and education
*Abbreviations for professional societies are in Table 1 footnote. BD=Bronchodilators CXR=Chest radiograph CT=Computed tomography DX=Diagnosis LVRS=Lung volume reduction surgery LTOT=Long-term oxygen therapy ABG=Arterial blood gas FEV₁=Forced expiratory volume in 1 second RHF=Right heart failure Alpha₁-AT=Alpha1-antitrypsin

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