Scope and Target Population:
Although chronic obstructive pulmonary disease (COPD) can occur in adults of any age, especially smokers, it most commonly occurs in people 45 years and older. The target population for this guideline is people with symptoms of stable COPD as well as acute exacerbations of COPD.

Clinical Highlights and Recommendations:

• Assess patients for symptoms and risk factors for COPD, including asking about tobacco use/exposure at every visit.
  
• Establish diagnosis and severity of COPD through spirometry, pre- and post-bronchodilator and chest radiograph in addition to history and physical examination.
  
• After establishing severity, assess patient needs for pharmacologic and non-pharmacologic treatment and provide appropriate therapy as indicated.
  
• Management of COPD should include an education plan suited to the patient's specific needs, encouragement of exercise, tobacco use cessation and other behavioral changes, and monitoring of immunization status.
  
• A trial of inhaled steroids is indicated for symptoms not controlled by scheduled bronchodilators.
  
• A course of systemic steroids is beneficial for COPD exacerbations.
  
• Tiotropium offers significant advantages compared to other bronchodilators to patients whose symptoms are not controlled by albuterol.
  
• For patients with severe symptoms, despite maximal medical therapy, lung volume reduction surgery and transplantation may be an option.
  
• Patients should be regularly assessed for hypoxemia; appropriate oxygen therapy should be prescribed accordingly.
  
• Physicians should discuss advance directives/health care directives and goals of care as early as possible.

Priority Aims:

1. Increase the quality and use of spirometry testing in the diagnosis of patients with COPD.
   
2. Increase the number of patients with COPD who receive information on the options for tobacco cessation and information on the risks of continued smoking.
   
3. Reduce COPD exacerbation requiring emergency department (ED) evaluation or hospital admission.
   
4. Increase the appropriate use of pharmacotherapy prescribed for patients with COPD.
   
5. Increase patients' education and management skills with COPD.
   
6. Increase the number of patients with COPD presenting with an acute exacerbation who have an oxymetric evaluation.