Clinical practice guidelines for chronic obstructive pulmonary disease: a review and comparison of current resources

The first clinical practice guidelines (CPGs) for the assessment and management of patients with chronic obstructive pulmonary disease (COPD) were published 30 years ago. These and subsequent CPGs issued by professional societies and other groups prior to 2000 were consensus recommendations based on expert opinion and available studies, and they have been criticized for being inconsistent and not explicitly evidence-based. The Global Initiative for Chronic Obstructive Lung Disease (GOLD), a joint project of the National Heart, Lung, and Blood Institute and the World Health Organization, released the first of a new generation of rigorous, evidence-based COPD guidelines in 2001. Since that time several other CPGs, notably those developed jointly by the American Thoracic Society (ATS) and the European Respiratory Society (ERS), and by the British National Collaborating Center for Chronic Conditions and Institute for Clinical Excellence, have also become available. While previous COPD guidelines had different severity-grading systems and differed in their therapy recommendations, the new CPGs are remarkably consistent and have very few areas of clinically relevant discrepancy. All are available free via the Internet, provide for regular revision and updating, and include materials for patients and the public, as well as for health-care providers. Although the GOLD and ATS-ERS guidelines both have international authorship and are intended for worldwide use, implementation of many of their recommendations (such as the requirement for spirometry in diagnosis and staging, an escalating management scheme that includes expensive inhaled medications and pulmonary rehabilitation, and consideration for lung-volume reduction surgery) remains beyond the reach of many patients and health care systems.