Clinical Practice Guideline - Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease

Recommendation:

Asuris supports the recommendation of the of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the content of the latest version of the guideline entitled Global Strategy for the Diagnosis, Management, and Prevention of COPD.

Other evidence based guidelines that are useful resources for managing patients with COPD include:

• Department of Veterans Affairs/Department of Defense (VA/DoD) Clinical Practice Guideline For Management Of Outpatient Chronic Obstructive Pulmonary Disease. Version 2.0 – 2007.
• Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines, the 2007 publication. American College of Chest Physicians (ACCP); American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR).
• Tobacco Use: Prevention, Cessation, and Control. Evidence Report/Technology Assessment, the June 2006 AHRQ Publication.

The American Thoracic Society / European Respiratory Society (ATS/ERS) publishes a consensus statement that uses GOLD standards for the basis of their recommendations.

Please refer to the web sites listed below for detailed information.  Differences between these sources should be discussed with your physician/provider of care.

Web Site Links:

From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2007; located at: http://www.goldcopd.org

VA/DoD (Department of Veterans Affairs/Department of Defense) Clinical Practice Guideline For Management Of Outpatient Chronic Obstructive Pulmonary Disease   Version 2.0 – 2007. Available at: http://www.oqp.med.va.gov/cpg/COPD/COPD_CPG/GOL.htm.

Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, Make B, Rochester CL, Zuwallack R, Herrerias C. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest 2007 May;131(5 Suppl):4S-42S. Complete summary available at: http://www.guideline.gov/summary/summary.aspx?ss=15&doc _id=10856&nbr=005669&string=pulmonary+AND+rehabilitation

Ranney L, Melvin C, Lux L, McClain E, Morgan L, Lohr K. Tobacco Use: Prevention, Cessation, and Control. Evidence Report/Technology Assessment No. 140. (Prepared by the RTI International−University of North Carolina Evidence-Based Practice Center under Contract No. 290-02-0016). AHRQ Publication No. 06-E015. Rockville, MD: Agency for Healthcare Research and Quality. June 2006. Available at http://www.ahrq.gov/downloads/pub/evidence/pdf/tobaccouse/tobuse.pdf

American Thoracic Society / European Respiratory Society Task Force. Standards for the Diagnosis and Management of Patients with COPD [Internet]. Version 1.2. New York: American Thoracic Society; 2004 [updated 2005 September 8]. Available from: http://www.thoracic.org/go/copd.

Position Statement:

Asuris supports the GOLD, VA/DoD, ACCP/AACVPR and AHRQ Tobacco Use guidelines because they are based on scientific evidence, and where evidence is lacking, on expert consensus.  The strength of  evidence supporting each recommendation is clearly indicated.  When there is not good evidence, recommendations are based on expert consensus and are clearly stated as such. The guidelines reflect the most current standard of care for COPD and tobacco prevention, cessation and control.

The ATS/ERS guideline is a consensus statement that utilizes documents such as GOLD as the basis for the their recommendations. The latest ATS/ERS update is 2005, citing the 2001 GOLD publication.

• Recommendations are based on a well-defined scientific literature search.
• The methods used to critically appraise the evidence supporting guideline recommendations are not readily transparent. 
• The guidelines clearly state the strength of the evidence for which recommendations are based. 
• Sources of funding:
  • Listed with noted conflict of interest disclosures, including pharmaceutical company sponsorships (GOLD)
  • Not stated or not transparent (VA, ACCP, Tobacco Use, and ATS/ERS)

Guideline Adoption and Recommended Use: 

This guideline has been adopted based on nationally recognized sources.  This guideline is based on the most recent medical evidence or a consensus on clinical treatment patterns by physicians in the selected field of practice. Asuris adopts guidelines to help practitioners and members make decisions about appropriate health care for specific conditions. Guidelines are not a substitute for professional medical advice.

Benefit Determination: 

Benefit determinations should be based in all cases on the applicable contract coverage. To the extent that there are any conflicts between these guidelines and the contract language, the contract language will control. 

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