Practical Pearls from the GOLD Guidelines on COPD

By Juan Garcia, MD, FCCP; and Stephen Jenkinson, MD, FCCP

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Reduce Risk Factors

Risk factors for the development of COPD include exposures of the lung to noxious agents and various host factors. Exposures include smoking (> 90% of cases), passive smoking, ambient air pol1ution, occupational dust and chemical exposures, and respiratory infections during childhood.

Host risk factors include AAT deficiency (< 1%), hyperresponsive airways, lung growth, and both sex and ethnicity (highest prevalence in the white male population).

Pearl: Smoking cessation is the single most effective—and cost-effective—intervention to reduce the risk of developing COPD and decreases its progression.

Pearl: Numerous studies indicate that nicotine replacement therapy in any form (nicotine gum, inhaler, nasal spray, transdermal patch, sublingual tablet, or lozenge) reliably increases long-term smoking abstinence rates. The antidepressants, bupropion and nortriptyline have also been shown to increase long-term quit rates. The antihypertensive drug clonidine can also be used to help a patient quit smoking, but side effects should be carefully reviewed with the patient.

Pearl: Special consideration should be given before using pharmacotherapy in selected populations, including people with medical contraindications, those smoking < 10 cigarettes/d, and pregnant or adolescent smokers.

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