IoelY ‘GOUNEIEGN (OB) AND PULMONAR REHABILITATIONCLINICAL PRACTICE GUIDELINES IN THE DIAGNOSIS AND MANAGEMENT OF (CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) IN THE PHILIPPINES ‘oti ann oD rr ean re alge ha © 4 Update: 2009 Version G2 Part CLINICAL PRACTICE GUIDELINES IN THE DIAGNOSIS AND MANAGEMENT OF STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Fdtor: Lenora C. Fernandes, MD, FPCCP ‘Assistant Ector Rome Tipones, MO, (PCCP Presillano Zaera, MO, FPCCP PROPONENTS: irs Lute Mn MD, PCC Advisers “Terence Gi, MD, FCCP Camilo. Roa MD, FPCCP ina Disa, MD, FCCP Tomas Realza, MD, FCCP Percival Paral, M, PCCP Members: Deagacias Abe It ND, FPCCP the Aionuevo, MD, PCCP Joven. Aaneta, MD, FPCCP “To: Aes, MD,FPCCP Daphne D. Bate, MD, FCCP ‘Agnes Ley C. Beleza, MD, FPCCP \eyda chine Bingas, MO, PCCP Celeste Mae Campornanes, MD, FPCCP ‘Nolntco Capa, MD, FPCCP (Ma, Tees, Catseatan MDFPCCP Chor De Vers, MD, PCCP Virgina Delos Reyes, MD, FPCCD ‘oscar ferdinand. Felicano, MD, FPCCP {Lenora C Fernandez, MD, FPCCP Nobono A Hance MD, PCCP ‘Chute Gari, MD, FPCCP ‘ler Cari, MD, FCCP ust Gargaleana, MD, FPCCP ‘Neen Guzman Banzon, MD, FPCCP Renato Herds, MD, FBCCP sto F. Woe, FPCCP Manuel Antonio Ko, Mi, FCCP Hameo Labo Ir aD, FECCP Jose Lagunzad MD, PCCP tenia A. Lanzona, MD, FPCCP Cast ls igo, MD, FCCP Peri anlapaz, MD, PCCP roi Cliton Many, MD. FPCCP Buenaventia Maina, MD, FPCCP (Caer Mendon, MD, TPC? Jenny Mendoza, MD, FPCCP Jeoiter Ar Meradoea Wi MD, FPCCP ese F Oreastas, MD, FPCCP Rodi Pagestpunsn je, MO Rot Pees, MD, FPCCP Mary Ales Polis, MD, FPCCP Percival Pal, MD, FPCCP Tvelyn Rages MD, FPCCP Tomnas M.Relza, MD, FPCCE Rhowerick lan Reyes, MD, FPCCP eo M, Saag, MD, FPCCP Ma. Bla Sisoco, MD, FPCCP Sullan Sy Noval, MD, PCCP Jose Edel V. Tamayo, MD, FPCC Mares Tan Tana, MD, FPCCP Denis Teo, MD, PCCP Romulo Uy, MD, FPCCPPart h CLINICAL PRACTICE GUIDELINES IN THE DIAGNOSIS AND MANAGEMENT OF EXACERBATION ‘OF COPD (ECOPD) Chairman and for: Renato Herradura MD, FCCP Members: lei A, Lazo, MD, FPECP ner Maen MD, FPCCP [Dennis Teo, MD, FPCCP Sout. Cay MD, PPC CGealiineD.Garca, MD, FRCCD Mara Peachy Lara. Villanueva, MD PROPONENTS: ce Leto Motor, MD, FPCCP- Council an COPD & Pulmonay Rehabiaion Robeno Barzaga, MD, FPCCP - Council on Pulmonary nections Avis: Mato co, MD, FCCP abeto Barzaga, MD, FPCCP inet Motor MO, FPCCP Lenora C. Fernandes, MD, FPECP interim Char To €-Alenza MD, PCCP Co-chair: Nowbeno A. Fanclsco, MO, FPCCP Members: uber Bene MD. ‘Ante David Rubio MD ‘iginia delos Reyes MD Fimer Gaia MD, PCCP Renato Hears MO, PCCP Tito olor MD, FPCCP Jalstige MD, FPP Perla Manlapaz ND, FPCCP Benvertrs Maing fe, MD (Car Mendoza MD, PCCP ery Menara MD Jennifer Am Nerina Wh MO, FPCCP RatoloPageapunan MD Roland Peez, MD, TPCCP Toms Realza MD, FPCCP hed an Reyes MD Tee Sariapuel MD ‘Ma, ll Susoco MO, fRECP an Sp. a 0 PC sulin Sy Nival MD, FPCCP Dennis Teo MD, FPCCP. Romulo Uy MD, FPCCP Avior: Rolo Cannpn, MD, FPccP Metta de Guia MD, FCCP Camilo Boa, je MD, FPCCPDanie-Fan MD, FCCP ‘Ghres Ya MD, FRCP Family Medicine Practitioner Advisers Bite Casilo MD, FPATP Loin Needs MD, FPARP © 1999 (Fis Version = Propones on Percal A Punzal, MD Members ‘Abner Ko, MO. Islas A Lanzona, MD. aynaveratra Medi Je, 0. Ma. olla Sisco, MD. Adisees Teresa de Gua, MO. Reodolo Cann, MD. ‘Caio os Je MD. ‘Renate Dantes, MD. ‘Member Societie/Groupsindlviduals of Mulisectoral Consultative Groups Pine Collage of Chest Pryscane Pilppne Academy of Fai Physcians Philipines Sovey of Retalsaion Medicine Phltppine Associaton ot Pulmnary Care Proline Assclatono Thoracic and Cardovasculr Suge, Deparment o Heath Pres TABLE OF CONTENTS: Part CLINICAL PRACTICE GUIDELINES IN THE DIAGNOSIS AND [MANAGEMENT OF STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (coro) 1. traduction IL, How prevalent s COPD inthe Philippines IV. Whatare the ik actors fr COPDE 'V. How do we diagnose COPD 1. Diagrosing COPD in ateas where ‘phoma not ely sealable Grading of COPD every F, How COPD diferente em her common eae of ‘baroctve lng diseases inthe Philines spec aubens & Twonehiectae 6G. Ongoir mentoring ae assent ‘i. How do we manage patents th sable COPD? [A Smoking cessation apt ege tere 1 General principles hamacologlc maragerent tera . Non-phammacobope manapement 1, Managerent comnuum for Sable COPD Parte CLINICAL PRACTICE GUIDELINES IN THE DIAGNOSIS AND MANAGEMENT OF EXACERBATION OF COPD (ECOPD) 1 ttn 1M, Epdriclogy IV ty ches hogy 1B. Arterl bid pes€.Spiramety AComncoaerois {B.ronchekttrs Di Mucolytes ‘Appendix 1. Suggested Quesons fr Fllowup Visks of COPD Patents ‘Append 2. Set Smoking ceseationivnton fr Physitans ‘Append 3, Conon Encountered Dg fr COPD a Plippnes by Genoie Names, Formulation and Cerneniy Encountered ‘rugs or COPD i the Palins by Canerc Nae Fulton and Boa stor Avalbl Pulmonary Rehabiltation Program Senices site Peer ppendin 4 art CLINICAL PRACTICE GUIDELINES IN THE DIAGNOSIS AND [MANAGEMENT OF STABLE CHRONIC OBSTRUCTIVE PULMONARY DISEASE (corp) |. INTRODUCTION (Chronic Obstructive Pulmonary Disease (COPD) i ne of the mot important sas of the st centuy, being a major cause of dexh and dealt, Mow epidemiological suces ers amet de persons of ely ee eaaliy sts COPD Fe reeeet ‘ver tine and are ret In ten than in women. The impact of COPD te ot oy ontined ots eects on the individuals heh but sso pamestes i the soca and conor specs wl In response to the ned wo belp prevent and manage COPD beter, the Philppow College ‘ot Chee Physictane publhed the Piping Consens Rept on COPD in 1999 (xe ‘Ropendic Te Tis tthe 2" update ofthe Phlyane Conse pon and Ws version takes ito acount the new sides tht have Ibsen published on COPD aa the latest \erson ofthe Gleb ata for Chronic Obsractve Lung Disease (GOLD) Worksop Report eed Global Sategy forthe Dinos, Management, and Prevention of COPD" ‘This 2008 document wi merely al peates on the 2005 Phippine Consens COPD Report since mos ofthe busi princes in pales, apo and managenert im cOPD have rine the sme The detent hopesto cater othe sce needs ‘he Phipps asa developing county and intended forthe use of pacing pyc tie che heath protestants vole a the ene of pacts wath ehonie Sbarava pulmonary dseast (COPD). The oa othe Pippin Consensus COPD Report aro: | primary health cae practitione nent and ntiating ‘anagerent of patents th COPD. {5 Postal based physicians im proiding appropiate and cost ‘tice car for COPD patents cerned ses fot the prevesion of hter deterioration of ting tancion ae subsequent complications; and inthe improve Inthe quality of ie f COPD paten ‘Suit led Real core workers in the cae of COPD pies, ‘alent restorer esearch nthe dagrons and management ot COPD nthe Pape The process usd in updating this pracice guideline was by: a) slection of Core Group to review the previous guideline. and identity topesaeas that needed revision, ‘eleion of crits recor bal ch Melle kf, sere Sor cee it In the teraure, (@) grading of avalable eudence, e)asessnent of locally valle recce f fmuibn, pstata anl revnon o ak mconmedne a Led fei a ites ein lowing he ten flthe US National Head, Tun, and Blood ste (NHLBI wich i cemparale to Ue aseasion use nthe 1999 practice gldeline: DESCRIPTION OF LEVELS OF EVIDENCE Feidence Catagory, [Sources 0 Evidence] Delton A Rondomized Evidence iftom endpoints of conrlliale | welldeigned RCP provide 2 (RCTS Rchbody of | anstent pate of nding athe dhe population tor which the secommerraton made. Caegory A Feules subaantl ruber of studies Involving stl numbers ofDESCRIPTION OF LEVELS OF EVIDENCE Fuidence Category [ Sourcos of fidence] Definition Reneomized viene om ents ® contedirats | sermon sist ce ony 2 (acta ented bay | nto nme a patent, pos te date Sulgeupansist RCT or tna aro CTs Inger, ‘acgay 8 petas ten ew sondomted alsa hey ates i tz, hey weve rer opsion hat rs ome argt Population th recon {heresuts are smewha incon Nowrndomized | Evidence i foniodcomeso © wh sewationa | uncon or nandanised als or ‘ten ‘tom bseratonal ce . ed ee Tidement | where the provision a some guidance ‘woe deemed valuable bu the clic peaeeeetg teeta ected silent 0 sy placemere Ione othe other categories. The Feel ceeeriiatee ieee ipeience or kode tat doe ot ‘meet the above ised rea ‘The tae deciting factor in all the recommen was what could eet the ypc Fine COPD patent mot ‘This documents clive ito ve pans that escusses the 1) dfn of COPD, rik {actor for developing COPD, (3) dagros, canton and morsonng of COPD, 0) ‘managernent of Sable COPD, (3) and managenert of COPD it acute exacerbaion. Recommendation forthe aypecs of COPD needing futher research and velerences Wed se placed the ero each cape The sections at writen ia bret and cance manner ep the reader imbibe the hey sui so that te document can be wed at bedside or athe ics The updtes tre incorporated nto the pres cone of te idling For futher elaboration ofthe [udines, the proponent ll be hsernaing the Soeur Hugh forse! frp Sea ern ean eae su. WHAT Is coPOr Key Poin: (© cOPDis a prevemable and testable deste characterized by atfow Titan that nox ly revere {© Theat tation ss usally bath progesive a associated with a abnormal Inlarsatory response of he lng to noxious particles or gases {© Chronic sirlow mean lect long hypeition which thers mechan ‘ole chaareatc exetiona dapren in COPD. {© Some sigtcare comer eandlers might conuibte tothe severiy of COPD in some indivi. Definition & Pathophysiology COPD ia preventable an uetable disease sate characte by aitflow Ynaion that et el eee Tent ely as ieee cee ‘eh an boon ianmatory respon othe hugs xis pails or gate Inhaition of noxious pails or ges, sich a¢cgnete smoke, iniees an abromal ‘terse inlanmatory imine resporse which i heightened by oxdaive ses ad Inbalnce of proteases an aiprotiases in the ung. These lead to the pathologie ‘hanger in COPD which ae" ition sah specie inammtory cel types ithe !innays and ang parenchyna, cus land ypertopty and goblet cell hyphae Yroninal snaps pecivanchial vat and sway wall tickening i the. peripheral Fencing away, citation and desracon of tespstory bronchioles and leo Sells eplysoma), ad endetheal cel stanton The pepral aay abstain tna Toso alveolar attachment toe ll anes ease the even alow lntation {haacerisic of COPD and hs leads rogresve a rapping cing expraton which ese ee ee eco career 9 leh aeaeed art peer tlevelope early in COPD, is icretued with exeice and i beleved to Be the main Inechansn buh the exerbonal dyspnea experienced by patents with COPD’. Gas ‘change sbromnliies an event pulsonary hyperesion and ight hea fae (oe Pumonale) rest as the disease peoeses