Chronic Obstructive Pulmonary Disease (COPD) is a clinical guideline for the evaluation and management of COPD and obstructive sleep apnea. Evidence-based criteria for screening, tests and treatments, including lung transplantation, smoking cessation programs, durable medical equipment and oxygen are described. Health plan and Medicare benefit coverage guidelines are included, as well as authoritative references, web links and resources.

Table of Contents

• Introduction
• Screening
• Pulmonary function tests (description, indications):
  • Blood gases
  • Diffusion capacity, lung compliance
  • Exhaled nitrous oxide
  • Lung volumes
  • Metacholine challenge
  • Pulse oximetry, overnight home-based oximetry
  • Spirometry; transtelephonic spirometry
  • Vital capacity
  • Cardiopulmonary exercise testing
  • Exhaled nitric acid testing for pulmonary disorders
  • References/resources for pulmonary function tests
• Fiberoptic bronchoscopy
• Fluorescence bronchoscopy/endoscopy
• Total body plethysmography
• Pilocarpine iontophoresis sweat test, quantitative
• Virtual lung scans or electron-beam computed tomography
• Obstructive sleep apnea (OSA)
• Sleep disorder studies/polysomnography
  • Actigraphy testing
  • Multiple sleep latency test (MSLT)
• Obstructive sleep apnea (OSA) therapies
  • CPAP for obstructive sleep apnea
  • Noninvasive positive-pressure ventilation (NPPV)/bilevel positive airway pressure (BiPAP)
  • Sleep apnea, noninvasive positive pressure ventilation (NPPV)/BiPAP, C-PAP references/resources
  • Palatal implants for obstructive sleep apnea (OSA)
  • Osteotomy (maxillary, mandibular) for sleep apnea
  • Uvulopalatopharyngoplasty (UPPP) and palatopharyngoplasty (PPP)
    • Laser assisted uvulopharyngoplasty (LAUP)
    • Radiofrequency volumetric tissue reduction (RFVTR) uvulopharyngoplasty
    • Weight reduction for OSA
• COPD therapies
• Cryotherapy for malignant endobronchial obstruction
• Electrophrenic pacemaker/diaphragmatic/phrenic nerve stimulator
• Inhaled nitric oxide (INO)
• Lung volume reduction surgery (LVRS)
• Noninvasive positive-pressure ventilation (NPPV)
• Phrenic nerve pacing/diaphragm pacing/phrenic nerve stimulator
• Pneumonia: admission criteria; duration and necessity of IV antibiotics; LOS
• Respiratory therapy services/physiotherapy
  • Postural drainage procedures and pulmonary exercises
• Pulmonary rehabilitation (PR)
  • Outpatient pulmonary rehabilitation (PR)
  • Pulmonary rehabilitation reference/resource list
• Smoking cessation benefits/coverage
• Pulmonary/lung transplants coverage
• Notes
• Pulmonary/respiratory DMS/DME
  • Airway clearance/high frequency chest wall oscillation devices
  • Mechanical in-exsufflation/in-exsufflator devices
  • Intrapulmonary percussive ventilator (IPV), Medicare NCD
  • Nebulizers
  • Oxygen coverage guidelines, outpatient
    • Portable oxygen guideline
    • Oxygen for travel
    • Prescribing oxygen therapy; references
  • Peak expiratory flow meters
  • Postural drainage boards/standers, boards and tilt tables
  • Respiratory assist devices
  • Suction pumps
  • Vaporizers
• References/resources
• American Association of Respiratory Care: Clinical Practice Guideline links
• Reference/resource list by topic
• Web resources and links
• Pulmonary notes