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Can Fam Physician
Vol. 54, No. 5, May 2008, pp.706 - 711
Copyright © 2008 by The College of Family Physicians of Canada
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Clinical Review

Approach to chronic obstructive pulmonary disease in primary care

David C. Todd, MD FRCPC, R. Andrew McIvor, MD MSc FRCPC, Stewart O. Pugsley, MD FRCPC and Gerard Cox, MB FRCPC
Dr Todd is an Assistant Professor of Medicine, Dr McIvor is a Professor of Medicine, Dr Pugsley is an Associate Clinical Professor of Medicine, and Dr Cox is a Professor of Medicine, all at McMaster University in Hamilton, Ont

Correspondence to: Dr R.A. McIvor, St Joseph’s Healthcare—Firestone Institute for Respiratory Health, 50 Charlton Ave E, Hamilton, ON L8N 4A6; telephone 905 522-1155; fax 905 521-6183; e-mailamcivor{at}stjosham.on.ca

OBJECTIVE To review the diagnosis, assessment of severity, and management of chronic obstructive pulmonary disease (COPD) and to address the systemic manifestations associated with COPD.

SOURCES OF INFORMATION PubMed was searched from January 2000 to December 2007 using the key words COPD, practice guidelines, randomized controlled trials, therapy, and health outcomes. The Canadian Thoracic Society guideline on management of COPD was carefully reviewed. The authors, who have extensive experience in care of patients with COPD, provided expert opinion.

MAIN MESSAGE Chronic obstructive pulmonary disease is a common systemic disease caused primarily by smoking. Spirometry is essential for diagnosis of COPD and should be integrated into primary care practice. Pharmacologic and nonpharmacologic therapy improves symptoms, capacity for exercise, and quality of life. Smoking cessation is the only intervention shown to slow disease progression. The systemic manifestations and comorbidity associated with COPD need to be identified and addressed to optimize health and quality of life.

CONCLUSION An evidence-based approach to managing COPD along with a primary care chronic disease management model could improve quality of life for patients with COPD.






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