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      Guidelines for diagnosis and management of chronic obstructive pulmonary disease: Joint ICS/NCCP (I) recommendations


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          Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the country. The Indian Chest Society (ICS) and the National College of Chest Physicians (NCCP) of India have joined hands to come out with these evidence-based guidelines to help the physicians at all levels of healthcare to diagnose and manage COPD in a scientific manner. Besides the International literature, the Indian studies were specifically analyzed to arrive at simple and practical recommendations. The evidence is presented under these five headings: (a) definitions, epidemiology, and disease burden; (b) disease assessment and diagnosis; (c) pharmacologic management of stable COPD; (d) management of acute exacerbations; and (e) nonpharmacologic and preventive measures. The modified grade system was used for classifying the quality of evidence as 1, 2, 3, or usual practice point (UPP). The strength of recommendation was graded as A or B depending upon the level of evidence.

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          Susceptibility to exacerbation in chronic obstructive pulmonary disease.

          Although we know that exacerbations are key events in chronic obstructive pulmonary disease (COPD), our understanding of their frequency, determinants, and effects is incomplete. In a large observational cohort, we tested the hypothesis that there is a frequent-exacerbation phenotype of COPD that is independent of disease severity. We analyzed the frequency and associations of exacerbation in 2138 patients enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Exacerbations were defined as events that led a care provider to prescribe antibiotics or corticosteroids (or both) or that led to hospitalization (severe exacerbations). Exacerbation frequency was observed over a period of 3 years. Exacerbations became more frequent (and more severe) as the severity of COPD increased; exacerbation rates in the first year of follow-up were 0.85 per person for patients with stage 2 COPD (with stage defined in accordance with Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages), 1.34 for patients with stage 3, and 2.00 for patients with stage 4. Overall, 22% of patients with stage 2 disease, 33% with stage 3, and 47% with stage 4 had frequent exacerbations (two or more in the first year of follow-up). The single best predictor of exacerbations, across all GOLD stages, was a history of exacerbations. The frequent-exacerbation phenotype appeared to be relatively stable over a period of 3 years and could be predicted on the basis of the patient's recall of previous treated events. In addition to its association with more severe disease and prior exacerbations, the phenotype was independently associated with a history of gastroesophageal reflux or heartburn, poorer quality of life, and elevated white-cell count. Although exacerbations become more frequent and more severe as COPD progresses, the rate at which they occur appears to reflect an independent susceptibility phenotype. This has implications for the targeting of exacerbation-prevention strategies across the spectrum of disease severity. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT00292552.)
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              Chronic obstructive pulmonary disease in non-smokers.

              Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Tobacco smoking is established as a major risk factor, but emerging evidence suggests that other risk factors are important, especially in developing countries. An estimated 25-45% of patients with COPD have never smoked; the burden of non-smoking COPD is therefore much higher than previously believed. About 3 billion people, half the worldwide population, are exposed to smoke from biomass fuel compared with 1.01 billion people who smoke tobacco, which suggests that exposure to biomass smoke might be the biggest risk factor for COPD globally. We review the evidence for the association of COPD with biomass fuel, occupational exposure to dusts and gases, history of pulmonary tuberculosis, chronic asthma, respiratory-tract infections during childhood, outdoor air pollution, and poor socioeconomic status.

                Author and article information

                Lung India
                Lung India
                Lung India : Official Organ of Indian Chest Society
                Medknow Publications & Media Pvt Ltd (India )
                Jul-Sep 2013
                : 30
                : 3
                : 228-267
                [1] Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
                [1 ] Department of Pulmonary Medicine, Indian Chest Society, India
                [2 ] Department of Pulmonary Medicine, National College of Chest Physicians, India
                Author notes
                Address for correspondence: Dr. Dheeraj Gupta, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh - 160 012, India. E-mail: dheeraj1910@ 123456gmail.com

                COPD Guidelines Working Group, India

                A. K. Janmeja, Chandigarh;

                Abhishek Goyal, Chandigarh;

                Ajay Handa, Delhi;

                Ashish Bhalla, Chandigarh;

                Bharat Gopal, Delhi;

                D. Dadhwal, Chandigarh;

                Dharmesh Patel, Vadodra;

                D. J. Christopher, Vellore;

                Dhruva Chaudhry, Rohtak;

                George D’Souza, Bangalore;

                Honey Sawhney, Chandigarh;

                Indranil Haldar, Kalyani;

                J. C. Suri, Delhi;

                J.S. Thakur, Chandigarh;

                Jai Kishan, Chandigarh;

                K. B. Gupta, Rohtak;

                Mandeep Garg, Chandigarh;

                Narayan Mishra, Berhampur;

                Navneet Sharma, Chandigarh;

                Nirmal K. Jain, Jaipur;

                Nusrat Shafiq, Chandigarh;

                P. Sarat, Chandigarh;

                Pallab Ray, Chandigarh;

                Parvaiz Koul, Srinagar;

                Pranab Baruwa, Guwahati;

                R. S. Bedi, Patiala;

                Raj Kumar, Delhi;

                Rajendra Prasad, Delhi;

                Rajesh Chawla, Delhi;

                Randeep Guleria, Delhi;

                S. K. Chhabra, Delhi;

                Sabir Mohammed, Bikaner;

                Samir Malhotra, Chandigarh;

                Sundeep Salvi, Pune;

                Sanjay Jain, Chandigarh;

                Surender Kashyap, Karnal;

                Surya Kant, Lucknow;

                U. P. S. Sidhu, Ludhiana;

                Vikas Gautam, Chandigarh;

                Virendra Singh, Jaipur;

                Vishal Chopra, Patiala

                Copyright: © Lung India

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


                Respiratory medicine
                asthma,chronic obstructive pulmonary disease,chronic bronchitis,emphysema,guidelines


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