Chronic Obstructive Pulmonary Disease (COPD)
Since 2002, the Global Initiative for Chronic Lung Disease (GOLD) Science Committee has reviewed published research on the management and prevention of COPD. The 2018 GOLD Report contains slight revisions of the GOLD 2017 Report. The 2018 report has been updated to include key peer- reviewed research publications from January 2016 to July 2017, systematic literature searches, and a double blind review by the GOLD Science committee. The Medical Advisory Council first adopted the GOLD guidelines in October of 2004 and every year since. Below are few key points from the 2018 GOLD Report:
- Adults with asthma were found to have a 12-fold higher risk of acquiring COPD over time, compared to those without asthma. The diagnosis Asthma-COPD Overlap Syndrome (ACOS) or Asthma-COPD Overlap (ACO) has been coined to acknowledge this overlap of the common disorders causing chronic airflow limitation rather than a distinct syndrome.
- COPD should be considered in any patient who has dyspnea, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease.
- Spirometry is required to make the diagnosis; the presence of a post-bronchodilator FEV1/FVC<0.07 confirms the presence of persistentairflow limitation.
- The goals of COPD assessment are to determine the level of airflow limitation, the impact of disease on the patient’s health status, and the risk of future events (such as exacerbations, hospital admissions, or death) in order to guide therapy.
- Chronic and progressive dyspnea is the most characteristic symptom of COPD. Cough with sputum production is present in up to 30% of patients.
- The best predictor of having frequent exacerbations (defined as two or more exacerbations per year) is a history of earlier treated events.
- Post-hoc analysis of two clinical trials in COPD patients suggests that blood eosinophil counts 1) are a biomarker of exacerbation risk in patients with a history of exacerbations and 2) can predict the effects of ICS on exacerbation prevention.
- Some studies have shown an increase in exacerbations and/or symptoms following Inhaled Corticosteroids (ICS) withdrawal, while others have not. There has been evidence of a modest decrease in FEV1 (approximately 40ml) with ICS withdrawal, which could be associated with increased baseline circulating eosinophil level. * Inhaler technique should be addressed regularly.
- In patients with stable COPD and resting or exercise-induced moderate desaturation long-term oxygen treatment should not be prescribed routinely.
- Observational studies have identified a significant relationship between poor inhaler use and symptom control in patients with COPD. Determinants of poor inhaler technique in asthma and COPD patients include: older age, use of multiple devices, and lack of previous inhaler technique education. Education improves inhalation technique in some, but not all, patients, especially when the “teach-back” approach is implemented.
- Pulmonary Rehabilitation has been shown to be the most effective therapeutic strategy to improve shortness of breath, health status, and exercise tolerance.
Below you will find links to the corresponding GOLD documents of 2018 update: