The ACP, ACCP, ATS and ERS give us this new clinical practice guideline & review on managing stable COPD. To sum up their recommendations:

1. If symptomatic, those with suspected COPD should be diagnosed with spirometry and offered treatment with bronchodilators if they indeed have COPD.

2. If FEV1 < 60% - then definitely treat with a single long-acting bronchodilator (LABA or anticholinergic).

3. And an inhaled steroid if you want to (this conflicts with GOLD's guideline that frequent exacerbations also be present).

4. Pulmonary rehabilitation if FEV1 < 50%; or earlier if you like.

5. Oxygen for the severely hypoxemic (paO2 < 55 mmHg or SaO2<=88%)

Oh, and smoking cessation counseling for everyone who smokes.

Were you expecting more?

Qaseem et al. Ann Intern Med 2011;155:179-191.