Clinical Practice Guidelines

COPD

2007 – Recommendations for Management of COPD

2008 – Slim Jim: COPD

“Highlights of this update include new epidemiological information on mortality and prevalence of COPD, which charts its emergence as a major health problem for women; a new section on common comorbidities in COPD; an increased emphasis on the meaningful benefits of combined pharmacological and non-pharmacological therapies; and a new discussion on the prevention of acute exacerbations. A revised stratification system for severity of airway obstruction is proposed, together with other suggestions on how best to clinically evaluate individual patients with this complex disease.”

— O’Donnell et al. 2007

2013 –Spirometry in Primary Care

“Canadian Thoracic Society clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Most people with asthma and COPD will be diagnosed in the primary care setting. The present position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province.”

— Coates et al. 2013

2013 – COPD Action Plan

“The goal of a COPD Action Plan is to help those with COPD prevent and manage exacerbations in conjunction with the healthcare professional team. The healthcare professional team should complete/review the following information with the patient:

  • A list of persons to contact when he/she needs help
  • A list of baseline symptoms and the actions to be taken to stay well
  • The symptoms indicating worsening COPD and the actions to be taken to manage the exacerbation
  • The symptoms which require urgent treatment”

— Canadian Thoracic Society 2013

Asthma

2012 – Diagnosis and Management of Asthma in Preschoolers, Children, and Adults

2012 – Slim Jim: Diagnosis and Management of Asthma in Preschoolers, Children, and Adults

“The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. “

— Lougheed et al. 2012

Sleep Apnea

2011 – Diagnosis and Treatment of Sleep Disordered Breathing

2011 – Slim Jim: Diagnosis and Treatment of Sleep Disordered Breathing

“The recommendations regarding maximum assessment wait times, portable monitoring, treatment of asymptomatic adult obstructive sleep apnea patients, treatment with conventional continuous positive airway pressure compared with automatic continuous positive airway pressure, and treatment of central sleep apnea syndrome in heart failure patients replace the recommendations in the 2006/2007 guidelines. The recommendations on bariatric surgery, complex sleep apnea and optimum positive airway pressure technologies are new topics, which were not covered in the 2006/2007 guidelines.”

— Fleetham et al. 2011

Pulmonary Vascular Disease

2010 – Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)

“Asymptomatic patients postpulmonary embolism should not be screened for CTEPH. In patients with pulmonary hypertension, the possibility of CTEPH should be routinely evaluated with initial ventilation/ perfusion lung scanning, not computed tomography angiography. Pulmonary endarterectomy surgery is the treatment of choice in patients with surgically accessible CTEPH, and may also be effective in CTEPH patients with disease in more ‘distal’ pulmonary arteries. The anatomical extent of CTEPH for surgical pulmonary endarterectomy is best-assessed by contrast pulmonary angiography, although positive computed tomography angiography may be acceptable. Novel medications indicated for the treatment of pulmonary hypertension may be effective for selected CTEPH patients.”

— Mehta et al. 2010