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A Review of COPD Non-pharmacologic Management & Lung Cancer Surveillance

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Today in our  #AMreport, we reviewed COPD and lung cancer surveillance in smokers. Our take home points for COPD focus on non-pharmacological management as sometimes it is overshadowed with an over-emphasis on pharmacologic management. In lung cancer surveillance for smokers, educate patients that low dose CT thorax is not a substitute for smoking cessation.

COPD Take Home Points: Non-Pharmacological Management

1.Smoking cessation is the most important goal in patients with COPD who actively smoke.
2. Oxygen therapy has proven mortality benefit for patients with severe COPD.
3.Pulmonary rehab should be considered for patients with symptomatic COPD with an FEV1 < 50% as it can help improve quality of life in that patient population.
4. Lung Volume Reduction Surgery (LVRS) should be considered for individuals with advanced COPD who have received maximal therapy (but LVRS confers no survival advantage in patients) with:

i.FEV1 >20 & ≤ 45 predicted
ii.Upper lobe emphysema predominance.
iii.Completed a trial of pulmonary rehab if eligible.

Great summary of RCT study comparing LVRS to Medical Therapy here:  http://www.nejm.org/doi/full/10.1056/NEJMoa030287

Lung Cancer Surveillance in Smokers Take Home Points

  1. Annual low dose CT thorax for lung cancer surveillance is recommended for:
    1. Persons aged 55-74  with a 30-pack year history of tobacco smoking who are current smokers OR quit within the last 15 years.*
  2. Inform your patients that screening for lung cancer with low-dose CT scan is not a substitute for smoking cessation.
  3. Smoking cessation is the most effective way to reduce risk of dying from lung cancer.
*Each society has slight variations in the guidelines for screening but there is a general consensus and agreement on the above (1A). See here for variations: http://www.cdc.gov/cancer/lung/pdf/guidelines.pdf

– B