NEW YORK (Reuters Health) – A new clinical practice guideline recommends bronchodilator monotherapy for patients with chronic obstructive pulmonary disease and an FEV1 less than 60% predicted. The choice of a long-acting inhaled anticholinergic or long-acting inhaled beta-agonist should be based on patient preference, cost and adverse effects.

The guideline on diagnosis and management of stable COPD was developed by the American College of Physicians (ACP), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), and European Respiratory Society (ERS), and the recommendations are published in the August 2nd issue of the Annals of Internal Medicine.

The report notes that 5% of adult Americans have COPD, and the annual economic cost is estimated to be $49.9 billion.

The first recommendation is that diagnosis of COPD should be based on spirometry results. However, spirometry should not be used to screen for airflow obstruction in patients without respiratory symptoms.

“The routine use of spirometry for patients without respiratory symptoms could lead to unnecessary testing, increased costs, unnecessary disease labeling, and the harms of long-term treatment with no known preventive effect on avoiding future symptoms,” said committee member Dr. Gerard Criner, of Temple University, Philadelphia, Pennsylvania, in a journal press release.

For patients found to have mild-to-moderate COPD with an FEV1 of 60% to 80% predicted, there is low-quality evidence that inhaled bronchodilators may be helpful, the authors advise.

For those with an FEV1 less than 60% predicted, monotherapy with an inhaled bronchodilator is recommended, as mentioned. However, based on moderate-quality evidence, the guideline suggests that combination inhaled therapy with long-acting anticholinergics, long-acting beta-agonists, or corticosteroids may be used. Still, the panel notes, “it remains unclear when combination therapy is preferred over monotherapy.”

Lead author Dr. Amir Qaseem, the ACP’s Director of Clinical Policy, and colleagues found strong evidence to recommend continuous oxygen therapy for patients with an FEV1 less than 50% and severe resting hypoxemia.

Pulmonary rehabilitation should also be prescribed for this subgroup of patients, and may be considered for patients with a higher FEV1 who have exercise limitations, the report advises.

Of course, added Dr. Qaseem in the press release, “It is important for patients with COPD to stop smoking and for physicians to help their patients to quit smoking.”

Ann Intern Med. 2011;155:179-191.