Chronic Obstructive Pulmonary Disease

[2010 new]

Introduction to this self-study CME activity

Purpose

Chronic Obstructive Pulmonary Disease (COPD) is the fourth-leading cause of death in the United States, accounting for over 120,000 deaths annually. The population burden for COPD continues to increase, with prevalence similar to diabetes and asthma.  COPD also can have a long pre-symptomatic phase. Of the estimated 24 million Americans with COPD, half are undiagnosed.  Both physicians and patients under recognize the potential benefits of appropriate disease management for COPD.

This CME activity presents a framework for managing chronic COPD, treating mild to moderate acute exacerbations, as well as improving symptoms, quality of life and lung function while reducing morbidity and mortality in patients with COPD.  Highlights of care explained in the activity include:

COPD is under diagnosed and misdiagnosed. Routine population screening is not recommended but early case finding is encouraged. Appropriate comprehensive treatment can improve symptoms and quality of life.

Diagnosis.

  • Consider COPD in any patient with dyspnea, chronic cough or sputum production, and/or a history of inhalational exposures known to be risk factors.
  • Pulmonary function testing with post-bronchodilator assessment demonstrating a reduced FEV1/FVC ratio is required for diagnosis; severity of FEV1 decline (measured as % of predicted FEV1) establishes severity.

Treatment.

  • Smoking cessation is the single most important intervention to slow the rate of lung function decline regardless of disease severity.
  • Chronic medication management includes: - Bronchodilators (B2-agonists and anticholinergics) in stepwise progression based on disease severity with the goal of improving symptoms.

-  Inhaled corticosteroids should be considered only for patients with severe disease (FEV1 < 50% predicted) and frequent (at least annual) exacerbations.

-  Supplemental oxygen if resting oxygen saturation ≤ 88% or PaO2 ≤ 55.

  • Acute exacerbation medication management includes bronchodilators (B2-agonists and anticholinergics), antibiotics, and corticosteroid therapy based on clinical indications.  Empiric antibiotics are recommended for patients with increased sputum purulence plus either increased dyspnea or increased sputum volume. Sputum culture is not routinely recommended.
  • Pulmonary rehabilitation should be considered for all patients with functional impairment.
  • Surgical therapy options include bullectomy, lung volume reduction surgery, and lung transplantation. Total life expectancy should be incorporated into shared decision making regarding the potential benefits of surgery. Pulmonary consultation is advised for consideration of surgical options.
  • Palliative care should be discussed with patients desiring less aggressive therapy, avoidance of endotracheal intubation, or symptomatic care at the end of life.This self-study activity is appropriate for primary care clinicians and other health care providers who provide care for patients with COPD.

Objectives.

Participants in this CME activity will understand and be able to implement evidence-based cost-effective clinical strategies for the diagnosis and treatment of chronic obstructive pulmonary disease in adults. 

Audience

This self-study activity is appropriate for primary care clinicians and other health care providers who provide care for patients with COPD.

Authors

Team Leaders

  • Davoren A Chick, MD
    General Medicine

Team Members

  • Paul J Grant, MD
    General Medicine
  • Meilan K Han, MD, MS
    Pulmonary Medicine
  • R Van Harrison, PhD
    Medical Education
  • Elisa B Picken, MD
    Family Medicine

Author Disclosures

Neither the team lead, the team members, nor the consultants have financial relationships with commercial companies whose products are discussed in this CME activity.
Davoren A. Chick, MD
(None)
Paul J. Grant, MD
(None)
MeiLan K. Han, MD
Consultant
Novartis, Nycomed
Speaker’s bureau
Boehringer Ingelheim, GlaxoSmithKline, CLS Boehring
Advisory board
CLS Boehring
R. Van Harrison, PhD
(None)
Elisa B. Picken, MD
(None)

Other Acknowledgements

UMHS Guidelines Oversight Team

  • Grant M. Greenberg, MD, MA., MHSA
  • Van Harrison, PhD

Literature Search Services

  • Taubman Medical Library

Production of Internet Format and Website Maintenance

  • Ellen Patrick-Dunlavey, MA

CME Accreditation and Credit Designation

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Michigan Medical School designates this enduring material for a maximum of 1 AMA/PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This CME activity was released in June 2010, with credit available through May 2013.  The activity was reviewed for currency of content in May 2013 and availability of credit extended through May 2016. The activity was reviewed for currency of content in June 2016 and availability of credit extended through June 2019. 

Method of Participation

  1. View the web pages. You may print the self-study text to read off-line.
  2. Complete the on-line learning assessment test with a score of 70% or higher.  After you initially take the test, the test will be immediately electronically scored. 
    If fewer than 70% of the questions are answered correctly, the questions that were not answered correctly will be noted in red.  Review the CME content related to those topics and retake the test.
    If 70% or more of the questions are answered correctly, the correct and incorrect answers for all questions will be shown along with explanations of the basis for the correct answer.  The link to register and receive credit is shown at the end of the items and explanations. 
  3. Complete the electronic credit request and activity evaluation.  An electronic certificate of participation will be provided immediately.
  4. Print the certificate of participation for your personal records.