GUIDELINES FOR THE MANAGEMENT OF CHRONIC OBSTRUCTIVE PULMONARY-DISEASE

Objective. This guideline has been developed in order to optimise the management of patients with chronic obstructive pulmonary disease (COP D) at all levels of the health care system in South Africa. It contain s an action plan for early recognition and appropriate treatment of th is common condition. Options. Treatment regimens are recommended for p atients with mild (stage I), moderate (stage II) and severe (stage III ) disease. Outcomes. Optimal management of patients with COPD may achi eve a reduction in breathlessness, improved quality of life, preventio n of complications and limitation of disease progression. Evidence. Th e Working Group comprised mainly pulmonologists, but included an anaes thetist, a pharmacologist and a physiotherapist. Detailed literature r eview with particular attention to similar guideline documents from Eu rope and the USA was performed before the meeting. Recommendations. St eps in the management of patients with COPD include early recognition of the disease, smoking cessation, treatment of airflow obstruction wi th appropriate drugs (singly or in combination), education and pulmona ry rehabilitation, and limitation of disease progression and complicat ions. Detailed recommendations are made with regard to the use and int erpretation of a trial of oral corticosteroid therapy. Indications for hospitalisation, intensive care unit admission and ventilatory suppor t are provided. Validation. This guideline is similar to those recomme nded by other groups outside South Africa. It was developed by a worki ng group of the South African Pulmonology Society and is endorsed by t he Medical Association of South Africa. Sponsors. The meeting of the W orking Group was sponsored by Boehringer Ingelheim. This sponsorship d id not influence the activities of the Group.