Recommendations for the management of COPD

Three sets of guidelines for the management of COPD that are widely recogni zed (from the European Respiratory Society [ERS], American Thoracic Society [ATS], and British Thoracic Society [BTS]) are reviewed and compared. None of the documents uses classic evidence-based documentation, and, in many i nstances, the recommendations are empiric because of a lack of scientific e vidence. Overall, there is strong agreement between the documents. All thre e guidelines recommend inhaled bronchodilators as first-line therapy. Antic holinergics are noted to be well. tolerated, although potential problems wi th beta(2)-agonists are mentioned. The ERS and BTS suggest that inhaled cor ticosteroids may be of value in patients documented to be steroid responder s, whereas the ATS does not recommend their use at all. All three guideline s support the use of oxygen and pulmonary rehabilitation. There are varying levels of disagreement between the guidelines related to the role of spiro metry, stratification of disease severity, and the use of theophylline and systemic corticosteroids. Other differences include the role for nebulizers and metered-dose inhalers, secretion clearance methodologies, and the trea tment of acute COPD exacerbations and acute respiratory failure. All three guidelines agree that more research is needed to improve our understanding and management of COPD.