Respiratory care: clinical guidance and practice resources
Guidelines, related conditions and patient education resources for chronic respiratory conditions
Chronic respiratory conditions are common, often progressive and significantly affect patients’ daily functioning and quality of life.
Family physicians play a central role in the early recognition, diagnosis and long-term management of respiratory disease, coordinating care across clinical settings and over time. This page provides evidence-based clinical guidance and patient education resources to support family physicians in caring for patients with chronic respiratory conditions and related comorbidities.
Guidelines and recommendations
Clinical practice guidelines
COPD exacerbation management
The guideline, Pharmacologic Management of COPD Exacerbations, was developed by the American Academy of Family Physicians (AAFP) and approved by the Board of Directors in April 2021. The guideline was then published in the American Family Physician.
Key recommendations
Systemic antibiotics should be prescribed for adults with acute exacerbations of COPD to improve clinical cure and reduce clinical failure. Choice of antibiotic should be based on local resistance patterns, affordability, and patient history and preferences.
Systemic corticosteroids should be prescribed for adults with acute exacerbations of COPD to reduce clinical failure. There is insufficient evidence to guide the dose, route of administration, or duration of treatment.
The guideline panel also noted that short-acting bronchodilators are routinely used to improve symptoms in patients with acute exacerbations of COPD. Read the full recommendation.
Clinical preventive service recommendations
The AAFP supports the U.S. Preventive Services Task Force (USPSTF) clinical preventive service recommendation on this topic. The task force concludes that Although COPD affects about 6% of U.S. adults and is a major cause of death, evidence shows that screening asymptomatic individuals does not improve outcomes. As a result, the USPSTF continues to recommend against COPD screening in adults who do not report respiratory symptoms. Read the full USPSTF recommendation.
Obstructive sleep apnea in adults is common and linked to serious health risks, including higher mortality, cardiovascular and cerebrovascular events, diabetes, cognitive impairment, reduced quality of life, and motor vehicle crashes. Although earlier data estimated notable prevalence among adults, the evidence remains inadequate to determine whether screening asymptomatic or unrecognized adults improves outcomes. USPSTF finds the current evidence insufficient to assess the benefits and harms of screening in the general adult population. Read the full USPSTF recommendation.
Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) affects around 15 million people in the U.S.* Chronic lower respiratory diseases, including COPD, are the fourth leading cause of death in the U.S. and the third leading cause of death worldwide.**
The evidence-based clinical guidance and patient education resources on this page support family physicians in caring for patients who have COPD through diagnosis, treatment, and coordination of care.
* Kochanek KD, Murphy SL, Xu J, et al. Deaths: final data for 2014. Natl Vital Stat Rep. 2016;65(4):1-122. AND #2. Ford ES, Murphy LB, Khavjou O, et al. Total and state-specific medical and absenteeism costs of COPD among adults aged ≥ 18 years in the United States for 2010 and projections through 2020. Chest. 2015; 147(1):31-45.
** Murphy SL, Xu J, Kochanek KD, et al. Mortality in the United States, 2017. NCHS Data Brief. 2018;(328):1-8. AND #4. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016 [published correction appears in Lancet. 2017;390(10106):e38]. Lancet. 2017;390(10100):1151-1210.
Scenario-based COPD practice resources
COPD exacerbations are serious and potentially preventable events that significantly increase morbidity and mortality. Proper assessment, diagnosis and management in accordance with practice guidelines are essential to improving patient outcomes and reducing the risks associated with exacerbations.
This fact sheet and accompanying video highlight the importance of follow-up care, treatable traits, and the role of family physicians and care teams.
Early identification of patients at risk for chronic obstructive pulmonary disease (COPD) exacerbations is critical.
This fact sheet and video highlight how using key diagnostic markers including prior exacerbations using eosinophil counts from a complete blood count with differential and the recognition of comorbidities, such as asthma, will help you determine the best prevention strategies.
Nonadherence isn't just a patient problem—it’s a health care team challenge. System-level barriers, limited time, and changes in insurance coverage can all contribute to nonadherence to COPD treatment.
This fact sheet and accompanying video provide guidance on a proactive, nonjudgmental approach to address nonadherence before it leads to worse symptoms and avoidable exacerbations.
Inside Family Medicine podcast
In this episode of Inside Family Medicine we hear from Dr. Barbara Yawn, a family physician and clinical researcher and former Chief Science Officer at the COPD Foundation, about recognizing and managing COPD exacerbations in primary care. Dr. Yawn explains why COPD is often missed due to gradual symptom onset and patients minimizing symptoms, and stresses asking targeted questions about dyspnea, activity tolerance, chronic cough, sputum changes, and frequent colds. She reviews recognizing exacerbations, instructions to call the office, outpatient treatment with short courses of systemic corticosteroids and antibiotics, and considering alternative diagnoses such as heart failure, pulmonary embolus, and pneumonia.
Webcast: The spectrum of COPD treatment
Improve your approach to COPD management
This free webcast covers care coordination best practices, co-morbidities associated with COPD, environmental factors and how social determinants of health influence the condition. Funded with the American Thoracic Society.
Webinar series: Interviewing for COPD
Learn techniques for interviewing a patient who presents with dyspnea. Watch the webinar. Funded with GlaxoSmithKline (GSK).
Learn how to assess a patient who presents with dyspnea. Watch the webinar. Funded with GlaxoSmithKline (GSK).
Learn to interview a patient after recent exacerbation episodes. Watch the webinar. Funded with GlaxoSmithKline (GSK).
Learn how to assess a patient with recent exacerbation episodes. Watch the webinar. Funded with GlaxoSmithKline (GSK).
Respiratory syncytial virus (RSV)
Respiratory syncytial virus (RSV) is a common virus that affects the lungs, making breathing difficult. The virus is common in children under age 2, though people of all ages can contract it. It is more serious for young and premature babies, and older adults with poor health.
RSV resources
Increasing respiratory syncytial virus (RSV) vaccination in adults 60 and older
Get up-to-date guidance to help you identify patients at higher risk for severe RSV and support informed conversations about vaccination. These resources cover recommendations from the Advisory Committee on Immunization Practices, available vaccines, key risk factors and practical strategies for discussing RSV vaccination with adults 60 and older.
Idiopathic pulmonary fibrosis
You play a key role in identifying possible cases of idiopathic pulmonary fibrosis and referring patients early for diagnosis and treatment. This resource provides foundational information on IPF, including symptoms, risk factors, diagnostic challenges and tools to support earlier recognition in primary care. Learn more.
Patient education
The AAFP patient education website FamilyDoctor.org provides many patient-facing resources.