health outcomes (assessed with the European Community Respiratory Health Survey) from baseline to 12 months, or any significant differences between groups. Abramson et al (2010) also reported that there were no significant differences in respiratory symptoms, asthma attacks, written asthma action plans, days lost from usual activities or health care utilisation. The LFA/TSANZ (2015) lists several possible explanations for the negative results, including limited power, few events and inclusion of doctor-diagnosed as opposed to spirometry-defined patients. Abramson (2014) The Concise Guide by Abramson et al (2014) suggests that severity of COPD should be monitored on a regular basis after initial diagnosis. The relevant recommendation is shown in Table 36. Table Abramson (2014): Recommendation relating to lung function and long-term monitoring Recommendation Grading of recommendation To guide ongoing management, assess COPD severity based on lung function and a Strong careful assessment of symptoms and signs, and review the history of recommendation; exacerbations at least annually. moderate-quality evidence Abbreviations: COPD, chronic obstructive pulmonary disease. While the guideline recommends ongoing lung function testing (spirometry), it notes that symptom severity may not correlate with spirometry criteria for severity (see Table 37). Furthermore, a history of previous exacerbations was identified as the best predictor of future exacerbations and possible decline in lung function. Table Abramson (2014): Guide to the severity of COPD Severity FEV1 (% Symptoms History of Comorbid predicted) exacerbations conditions Breathlessness on moderate exertion Mild 60-80 Frequency may Present across Recurrent chest infections increase with all severity Little or no effect on daily activities severity groups Increasing dyspnoea Moderate 40-59 Frequency may Present across Breathlessness walking on level ground increase with all severity Increasing limitation of daily activities severity groups Cough and sputum production Exacerbations requiring corticosteroids and/or antibiotics Dyspnoea on minimal exertion Severe < 40 Frequency may Present across Daily activities severely curtailed increase with all severity Experiencing regular sputum production severity groups Chronic cough Source: Abramson et al (2014); Table 1, p. 6. Note: Common comorbid conditions include cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, anxiety or depression, lung cancer, peripheral vascular disease and sleep apnoea.
health outcomes (assessed with the European Community Respiratory Health Survey) from baseline to 12 months, or any significant differences between groups. Abramson et al (2010) also reported that there were no significant differences in respiratory symptoms, asthma attacks, written asthma action plans, days lost from usual activities or health care utilisation. The LFA/TSANZ (2015) lists several possible explanations for the negative results, including limited power, few events and inclusion of doctor-diagnosed as opposed to spirometry-defined patients. Abramson (2014) The Concise Guide by Abramson et al (2014) suggests that severity of COPD should be monitored on a regular basis after initial diagnosis. The relevant recommendation is shown in Table 36. Table Abramson (2014): Recommendation relating to lung function and long-term monitoring Recommendation Grading of recommendation To guide ongoing management, assess COPD severity based on lung function and a careful assessment of symptoms and signs, and review the history of exacerbations at least annually. Strong recommendation; moderate-quality evidence Abbreviations: COPD, chronic obstructive pulmonary disease. While the guideline recommends ongoing lung function testing (spirometry), it notes that symptom severity may not correlate with spirometry criteria for severity (see Table 37). Furthermore, a history of previous exacerbations was identified as the best predictor of future exacerbations and possible decline in lung function. Table Abramson (2014): Guide to the severity of COPD Severity FEV1 (% predicted) Symptoms History of exacerbations Comorbid conditions Mild 60-80 Breathlessness on moderate exertion Recurrent chest infections Little or no effect on daily activities Frequency may increase with severity Present across all severity groups Moderate 40-59 Increasing dyspnoea Breathlessness walking on level ground Increasing limitation of daily activities Cough and sputum production Exacerbations requiring corticosteroids and/or antibiotics Frequency may increase with severity Present across all severity groups Severe < 40 Dyspnoea on minimal exertion Daily activities severely curtailed Experiencing regular sputum production Chronic cough Frequency may increase with severity Present across all severity groups Source: Abramson et al (2014); Table 1, p. 6. Note: Common comorbid conditions include cardiovascular disease, skeletal muscle dysfunction, metabolic syndrome, osteoporosis, anxiety or depression, lung cancer, peripheral vascular disease and sleep apnoea.