Diagnosis and management of stable chronic obstructive pulmonary disease: A clinical practice guideline from the American College of Physicians

Recommendation 1: In patients with respiratory symptoms, particularly dyspnea, spirometry should be performed to diagnose airflow obstruction. Spirometry should not be used to screen for airflow obstruction in asymptomatic individuals. (Grade: strong recommendation, moderate-quality evidence.) Recommendation 2: Treatment for stable chronic obstructive pulmonary disease (COPD) should be reserved for patients who have respiratory symptoms and FEV₁ less than 60% predicted, as documented by spirometry. (Grade: strong recommendation, moderate-quality evidence.) Recommendation 3: Clinicians should prescribe 1 of the following maintenance monotherapies for symptomatic patients with COPD and FEV₁ less than 60% predicted: long-acting inhaled β-agonists, long-acting inhaled anticholinergics, or inhaled corticosteroids. (Grade: strong recommendation, high-quality evidence.) Recommendation 4: Clinicians may consider combination inhaled therapies for symptomatic patients with COPD and FEV₁ less than 60% predicted. (Grade: weak recommendation, moderate-quality evidence.) Recommendation 5: Clinicians should prescribe oxygen therapy in patients with COPD and resting hypoxemia (PaO₂ ≤55 mm Hg). (Grade: strong recommendation, moderate-quality evidence.) Recommendation 6: Clinicians should consider prescribing pulmonary rehabilitation in symptomatic individuals with COPD who have an FEV₁ less than 50% predicted. (Grade: weak recommendation, moderate-quality evidence.)