ACE Clinical Guidances (ACGs)

ACGs* provide concise, evidence-based recommendations to inform specific areas of clinical practice and serve as a common starting point nationally for clinical decision-making. ACGs are underpinned by a wide array of considerations contextualised to Singapore, based on best available evidence at the time of development. Each ACG is developed in collaboration with a multidisciplinary group of local experts representing relevant specialties and practice settings. ACGs are not exhaustive of the subject matter and do not replace clinical judgement. 

Registered doctors, pharmacists and nurses may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A/ Category V-B for reading each ACG.

*previously known as Appropriate Care Guides
Published on 25 Sep 2018
Last Updated on 03 Jun 2024
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This ACE Clinical Guidance (ACG) highlights the diagnostic approach for chronic obstructive pulmonary disease (COPD), including differential diagnosis with relevant conditions such as asthma. Diagnostic recommendations are complemented by a supplementary guide on how to interpret spirometry reports, as well as a list of spirometry sites in Singapore that are open to external referrals. The ACG also covers non-pharmacological and pharmacological management options for patients with stable COPD, with a focus on the importance of smoking cessation, and appropriate use of bronchodilators or inhaled corticosteroids.  

First published in 2018, guidance on COPD has been updated in 2024 to consolidate diagnosis and management recommendations in one ACG, incorporating the latest evidence where relevant. 

Download the PDF below to access the full ACG.

Registered doctors, pharmacists and nurses may claim 1 Continuing Medical Education (CME)/Continuing Professional Education (CPE) point under category 3A/ category V-B for reading each ACG.

ACG recommendations 
1.Suspect chronic obstructive pulmonary disease (COPD) in any patient with at least one relevant symptom and risk factor.
2.Diagnose COPD in patients with relevant symptoms and risk factors who have airflow obstruction detected via spirometry (post‐bronchodilator FEV1/FVC <0.7).
3.Regularly assess symptoms and exacerbation risk for all patients with COPD.
4.Explain the benefits of smoking cessation on COPD progression and strongly encourage those who smoke to quit.
5.Start bronchodilator treatment, preferably a long-acting bronchodilator, for patients with infrequent or less intense symptoms and lower risk of exacerbation.
6.Start dual bronchodilator therapy with long-acting muscarinic antagonist (LAMA) + long-acting beta2-agonist (LABA) for patients with frequent or intense COPD symptoms, or a higher risk of exacerbations.
7.Consider triple therapy with LAMA + LABA + inhaled corticosteroid (ICS) for patients with frequent COPD exacerbations and eosinophilia.
8.Assess inhaler technique and medication adherence at every visit and provide support to ensure optimal benefits from medications.

Chronic obstructive pulmonary disease – diagnosis and management (June 2024) Chronic obstructive pulmonary disease – diagnosis and management references (June 2024) Supplementary guide on open-access spirometry in Singapore (June2024) Supplementary guide on interpreting spirometry reports (June 2024)


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