Implementing the 2023 Canadian Thoracic Society guideline on pharmacotherapy in patients with stable chronic obstructive pulmonary disease in primary care.

Abstract

Objective: To increase family physician (FP) awareness of the 2023 Canadian Thoracic Society (CTS) guideline recommendations on pharmacotherapy in patients with stable chronic obstructive pulmonary disease (COPD) and self-efficacy in implementing the recommendations in primary care to achieve 3 high-priority patient outcomes.

Quality of evidence: Strength and certainty of pharmacotherapy recommendations is based on meta-analysis of evidence. The strength of recommendations ranges from weak to strong and certainty ranges from low to high.

Main message: Provider awareness and self-efficacy are 2 of the most employed strategies to facilitate guideline implementation. The 2023 CTS pharmacotherapy recommendations for the management of stable COPD are based on assessment of treatable traits including symptom burden, health status, and risk of exacerbations. Key pharmacotherapy recommendations include single long-acting bronchodilator (LABD) for patients with low symptom burden and mild health status impairment; dual long-acting bronchodilator for patients with moderate-to-high symptom burden and health status impairment but low risk for exacerbations; and single-inhaler triple therapy (over dual LABD or inhaled corticosteroid and long-acting β₂-adrenergic agonist) for patients with high symptom burden and health status impairment and high risk for exacerbations to reduce mortality.

Conclusion: Various implementation strategies, including guideline awareness and provider self-efficacy, aim to reduce the gap between guidelines and real-world care. This synopsis aims to familiarize FPs with recommended pharmacotherapy in the context of stable COPD and gain the necessary confidence to apply the recommendations in their practices to alleviate symptoms, prevent exacerbations, and reduce mortality.