Group A
In patients with a major discrepancy between the perceiverd level of symptoms and severity of airflow limitation, further evaluation is warranted.
Adapted from: Global Initiative for Chronic Obstructive Lung Disease; 2017.
Group B
In patients with a major discrepancy between the perceiverd level of symptoms and severity of airflow limitation, further evaluation is warranted.
Adapted from: Global Initiative for Chronic Obstructive Lung Disease; 2017.
Group C
In patients with a major discrepancy between the perceiverd level of symptoms and severity of airflow limitation, further evaluation is warranted.
Adapted from: Global Initiative for Chronic Obstructive Lung Disease; 2017.
Group D
In patients with a major discrepancy between the perceiverd level of symptoms and severity of airflow limitation, further evaluation is warranted.
Adapted from: Global Initiative for Chronic Obstructive Lung Disease; 2017.
Nonpharmacological treatment options
The GOLD Standards
2017 update: what you need to know
Discover key updates to the 2017 GOLD Report and how these new revisions may impact your care practice.
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released their latest report with recommendations for the assessment and treatment of chronic obstructive pulmonary disease (COPD). Below, we review key changes and their potential impact on your practice.
COPD is a treatable condition. It may not be curable yet, but there is always something that can be done to improve a patient’s quality of life.”
Gerard Criner, MD, FACP, FACCP
Division of Pulmonary and Critical Care Medicine Temple University School of Medicine
Chapter 1: redefining COPD
The definition of COPD has been broadened to include the impact of chronic respiratory symptoms and the role airway abnormalities play in the development of COPD. The causes of COPD are analyzed relative to medical history and environmental exposures.
Key takeaway
Broader inclusion criteria means that there may be a larger patient population affected by COPD. It is critical to recognize that chronic respiratory symptoms may precede airflow limitations and that symptoms may also exist in patients with normal spirometry.
Chapter 2: a refined ABCD assessment
The ABCD assessment tool has been updated to separate airflow limitations from clinical parameters. With this change, the process of categorizing patients no longer relies solely on spirometry. While spirometry is required to make a COPD diagnosis, the condition should be considered in any patient who has dyspnea, chronic cough, sputum production, or a history of exposure to risk factors. ABCD categories should now be assigned based on respiratory symptoms and each patient’s individual history of exacerbations.
The refined ABCD assessment tool
Consider this patient
Adapted from: Global Initiative for Chronic Obstructive Lung Disease; 2017.
Key takeaway
The refined ABCD assessment tool now clearly shows what is being evaluated. Once a diagnosis is made, the updated tool allows for better stratification of patients and opens the door to a more individualized treatment approach.
Chapter 3: support for nonpharmacological therapies
Evidence continues to build for nonpharmacological therapies in the treatment of COPD. These treatments, combined with advanced patient stratification methods, are making it possible for physicians to provide a more robust treatment approach.
Nonpharmacological treatment options
Pulmonary rehab: Activities including muscle strengthening and endurance training improve dyspnea, quality of life, and exercise tolerance in stable patients.
Self-management: Technical information about disease, medication, and device usage has proven to be insufficient in empowering patients to manage their own disease. Beyond this education, self-management intervention and ongoing engagement with healthcare teams has shown to improve long-term health and decrease hospitalizations.
Integrated care: Successful treatment of COPD requires the input of multiple care providers. Integrated care should be delivered and individualized to each patient and their stage of illness. Palliative care: Care teams should focus on relieving patient suffering and improving their overall quality of life. This includes working with and educating family members or caretakers and helping to facilitate discussions around end-of-life care.
Noninvasive ventilation (NIV): In the event of an exacerbation, NIV has been shown to improve acute respiratory acidosis, lower respiratory rates, and help with breathlessness. In addition, intubation rates and mortality have shown to decrease with NIV.
Key takeaway
Nonpharmacological treatment options not only complement drug therapy but also help empower patients to take ownership of their own care. These interventions should be considered relative to treatment and end-of-life goals.
Chapter 4: personalized COPD care
GOLD introduces a shift toward better patient segmentation and more personalized approaches to treatment. Care teams should consider individual disease presentation and future risk of exacerbations.
Key takeaway
The 2 main clinical goals for treating patients with COPD are to:
Reduce symptoms by:
Reduce risk by:
The benefits and risks of various treatment plans should be tailored to individual patient characteristics including symptom severity, risk of exacerbations, side effects, comorbidities, and specific underlying mechanisms.
Raising the standards
Source: Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2017 Report. http://goldcopd.org. Accessed December 9, 2016.
As we uncover better protocols for diagnosis and treatment, we open new possibilities for better outcomes. These new GOLD Standards are now in your hands, in your ongoing efforts to improve your patients’ lives and your institution’s performance.
As always, COPD Insider is your committed partner at every breath.
