Management of chronic obstructive pulmonary disease-A position statement of the South African Thoracic Society: 2019 update.

Objective To revise the South African guideline for the management of COPD based on emerging research that has informed updated recommendations. Key points Smoking is the major cause of COPD, HIV infection, exposure to biomass fuels and tuberculosis are important additional factors. Spirometry is important for the diagnosis of COPD. COPD is either undiagnosed or diagnosed too late, thus limiting the benefit of therapeutic interventions; performing spirometry in at-risk individuals will help to identify COPD early. COPD should be managed as a multisystem disease with attention to comorbidities, particularly cardiovascular disease. Primary and secondary prevention are the most cost-effective strategies in managing COPD. Smoking cessation as well as avoidance of other risk factors can prevent the development of COPD and retard disease progression. Bronchodilators [long-acting muscarinic antagonist (LAMA) or long-acting beta-2 agonists (LABA)] are the mainstay of pharmacotherapy, relieving dyspnoea, reducing acute exacerbations, reducing rate of disease progression and improving quality of life. Inhaled corticosteroids (ICS) are recommended in patients with frequent exacerbations and those with peripheral blood eosinophilia and have a synergistic effect with bronchodilators in improving lung function, quality of life and reducing exacerbation frequency. Oral corticosteroids are not recommended for maintenance treatment of COPD. A therapeutic trial of oral corticosteroids to distinguish corticosteroid responders from non-responders is not recommended. Acute exacerbations of COPD contribute significantly to health care costs, accelerates loss of lung function and increases mortality. A short course of oral corticosteroids (5 days) has been shown to be beneficial in acute exacerbations. Antibiotics are indicated during acute exacerbations associated with purulent sputum. Lifestyle modification, pulmonary rehabilitation (PR), pneumococcal vaccination and annual influenza vaccination are recommended for COPD patients.