Screening for lung cancer: US preventive services task force recommendation statement. Bloodeosinophil counts of less than 100 cells per microlitre can be used to predict a low likelihood of a beneficial ICS response: escalation to LABA/LAMA/ICS. The Committee does not make recommendations for therapies that have not been approved by at least one major regulatory agency. When COPD is part of a multimorbidity care plan, attention should be directed to ensure simplicity of treatment and to minimise polypharmacy. Figure 3: Recommended pathways for follow-up treatment based on predominant symptoms, current therapy, and blood eosinophil count2, LABA=long-acting beta2agonist; LAMA=long-acting muscarinic antagonist; ICS=inhaled corticosteroid; eos=blood eosinophil count in cells per microlitre; FEV1 =forced expiratory volume in 1 second. Available at: www.goldcopd.org Reproduced with permission. COPD should be considered in any patient who has dyspnoea, chronic cough or sputum production, a history of recurrent lower respiratory tract infections, and/or a history of exposure to risk factors for the disease. They should also undergo assessment of either dyspnoea using the modified Medical Research Council questionnaire, or symptoms using COPD assessment test (CAT). Bulk Order Request Form Global Initiative for Chronic Obstructive Lung Disease GOLD, COPD Diagnosis and Management At-A-Glance Desk Reference 2016, Remote COPD Patient Follow-Up During COVID-19 Pandemic Restrictions, Asthma, COPD, and Asthma-COPD Overlap Syndrome. Treatment trials in young patients with COPD and pre-COPD patients: time to move forward. Effectiveness of COVID-19 vaccines in ambulatory and inpatient care settings. COPD=chronic obstructive pulmonary disease; FEV1 =forced expiratory volume in 1 second; FVC=forced vital capacity; GOLD=Global Initiative for Chronic Obstructive Lung Disease; CAT=COPD Assessment Test; mMRC=modified British Medical Research Council Breathlessness Score, Consultant Physician and Honorary Professor of Respiratory Medicine, University of Exeter Medical School, Member of the GOLD Board of Directors and Science Committee, Member of the GOLD Board of Directors and Science Committee; sponsorship to attend international meetings, and honoraria for lecturing, attending advisory boards and preparing educational materials from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, CSL Behring, GSK, Novartis, Pfizer, Sandoz, Sanofi, and Teva, written by Dr David Jenner, GP, Cullompton, Devon. Reflect on what you have learned after reading this article with our interactive record. Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial. At all stages, dyspnoea due to other causes (not COPD) should be investigated and treated appropriately. Pharmacotherapy and nicotine replacement reliably increase long-term smoking abstinence rates. Resting oxygenation at sea level does not exclude the development of severe hypoxemia when travelling by air. These indicators are not diagnostic themselves, but the presence of multiple key indicators increases the probability of a diagnosis of COPD. Patients should be encouragedto keep active at home and can be supported by home-based rehabilitation programmes, Technology-based solutions, such as web-based or smartphone applications may be usefulto support home rehabilitation during the pandemic. Patients should receive their annual flu vaccination, Many pulmonary rehabilitation programmes have been suspended during the pandemic to reduce risks of spreadingSARS-CoV-2. No major changes have been made to the recommendations on nonpharmacological therapy, which remains an important component of initial and follow-up management.2 Nonpharmacological approaches, such as smoking cessation and pulmonary rehabilitation, are essential in COPD management and, in my opinion, they often have a greater impact than drug therapy. In patients treated with LABA/LAMA/ICS who still have exacerbations the following options may be considered: Non-pharmacological treatment is complementary to pharmacological treatment and should form part of the comprehensive management of COPD, After receiving a diagnosis of COPD a patient should be given further information about the condition. LABA/ICS may be preferred for patients with a history or findings suggestive of asthma. Consider COPD, and perform spirometry, if any of these indicators are present in an individual over age 40. all Group A patients should be offered bronchodilator treatment based on its effect on breathlessness. They should also ensure they have enough medication, Patients should be encouraged to use reputable resources for medical information regardingCOVID-19 and its management, On current evidence, patients with COPD do not seem to be at greatly increased risk of infection withSARS-CoV-2, but this may reflect the effect of protective strategies. Global Initiative for Chronic Obstructive Lung Disease GOLD, COPD Diagnosis and Management At-A-Glance Desk Reference 2016, Remote COPD Patient Follow-Up During COVID-19 Pandemic Restrictions, Asthma, COPD, and Asthma-COPD Overlap Syndrome. One of the key strengths of the GOLD report is that, unlike the NICE guideline, 1 it is updated annually. Following an exacerbation, appropriate measures for exacerbation prevention should be initiated. Identify which box corresponds to the patients current treatment. Switching inhaler device or molecules can also be considered. View list of references for the 2022 Pocket Guide. Martinez-Garcia M, Faner R, Oscullo G et al. Published in July 2022, this guideline provides key information and advice for primary care clinicians supporting patients with long COVID, This Guidelines for Pharmacy summary covers recommendations on diagnosis, assessment, differential diagnosis, and management of allergic rhinitis, This updated summary provides comprehensive guidance about flu immunisation for public health professionals, Covering management and prescribing options for people with COPD, This Guidelines summary covers the presentation, assessment, and review of bronchiectasis in a primary care setting, Core principles of asthma management, inhaler selection and use, and referral guidance, from the All Wales Medicines Strategy Group, This site is intended for UK healthcare professionals, Dr Angelika Razzaque Q&AAcne: an update on management, including the NICE guidance, Global Initiative for Chronic Obstructive Lung Disease. For patients with persistent breathlessness or exercise limitation on LABA/ICS treatment, LAMA can be added to escalate to triple therapy: alternatively, switching from LABA/ICS to LABA/LAMA should be considered if the original indication for ICS was inappropriate (for example, an ICS was used to treat symptoms in the absence of a history of exacerbations), or there has been a lack of response to ICS treatment, or if ICS side-effects warrant discontinuation. See Algorithm 2 for an overview of initial pharmacological treatment. November 2021. Palliative approaches are effective in controlling symptoms in advanced COPD. The British Lung Foundation also provides useful information for patients in the UK (www.blf.org.uk). End-of-life care should include discussions with patients and their families about their views on resuscitation, advance directives, and place of death preferences. Krist A, Davidson K, Mangione C et al. COPD often coexists with other diseases (comorbidities) that may have a significant impact on disease course, In general, the presence of comorbidities should not alter COPD treatment and comorbidities should be treated per usual standards regardless of the presence of COPD, Cardiovascular diseases are common and important comorbidities in COPD, Lung cancer is frequently seen in patients with COPD and is a major cause of death, annual low-dose CT scan (LDCT) is recommended for lung cancer screening in patients with COPD due to smoking according to recommendations for the general population, annual LDCT is not recommended for lung cancer screening in patients with COPD not due to smoking, due to insufficient data to establish benefit over harm, Osteoporosis and depression/anxiety are frequent, important comorbidities in COPD, are often under diagnosed, and are associated with poor health status and prognosis, Gastro-oesophageal reflux is associated with an increased risk of exacerbations and poorer health status. GLOBAL STRATEGY FOR PREVENTION, DIAGNOSIS AND MANAGEMENT OF COPD: 2022 Report. This summary includes information on the diagnosis, assessment, and management of stable chronic obstructive pulmonary disease (COPD), management of exacerbations, and COPD and comorbidities. To achieve these goals, the GOLD report recommends that assessment of people with suspected COPD must consider:2, The degree of FEV1 impairment, expressed as a percentage of the predicted value, is used to determine the GOLD stage (14), but the level of symptoms as determined by the modified Medical Research Council Breathlessness Score or the COPD Assessment Test, and the risk of exacerbations based on the number of moderate or severe exacerbations in the previous year, are used to determine the patients GOLD group (AD, see Figure 1).2 The 2022 report emphasises that this assessment of symptoms and exacerbation risk is recommended only as a basis for determining initial therapy, and is not designed for reassessing patients during follow up.2. Global Initiative for Chronic Obstructive Lung Disease GOLD, COPD Diagnosis and Management At-A-Glance Desk Reference 2016, Remote COPD Patient Follow-Up During COVID-19 Pandemic Restrictions, Asthma, COPD, and Asthma-COPD Overlap Syndrome. Patients should stay in contact with their friends and families by telecommunication andcontinue to keep active. This summary includes information on the diagnosis, assessment, and management of stable chronic obstructive pulmonary disease (COPD), management of exacerbations, and COPD and comorbidities. Major revisions were published in 2007, 2011, and 2017, and the 2021 report contains a new chapter on COPD and COVID-19. View list of references for the 2022 Pocket Guide. Antibody testing may be used to support clinical assessment of patients who present late. In the absence of specific studies, these general considerations would also apply to COPD patients infectedwith SARS-CoV-2. The need to treat primarily dyspnoea/exercise limitation or prevent exacerbations further should be evaluated. At follow up, treatment should be escalated or de-escalated based on: the presence of breathlessness and exercise limitation, the continued occurrence of exacerbations, Nonpharmacological therapies, including smoking cessation and rehabilitation, continue to play a vital role in COPD management, People with COPD should be included in lung cancer screening programmes, Infection control and public health measures have had a marked impact on the occurrence of COPD exacerbations, No changes to the management of COPD are required during the pandemic. Influenza vaccination is recommended for all patients with COPD, Pneumococcal vaccinations are recommended for all patients over 65 years of age, and are also recommended in younger patients with significant comorbid conditions including chronic heart or lung disease, People with COPD should have the COVID-19 vaccination in line with national recommendations. Anychange in treatment requires a subsequent review of the clinical response, including side effects. If COVID-19 infection is suspected, then reverse-transcription polymerase chain reaction testing should be conducted. Patients who developed mild COVID-19 should be followed with the usual protocols used for COPD patients. These features tend to be characteristic of the respective diseases, but are not mandatory. Download GOLD Teaching Slide Set BULK ORDERS Please fill out the form to contact us regarding bulk order requests. GOLD, 2022. There is a risk that patients may exhale contaminated aerosol, and dropletsproduced by coughing when using a nebuliser may be dispersed more widely by the driving gas, If possible, pressurised metered-dose inhalers, dry-powder inhalers, and soft-mist inhalers should be used for drug delivery instead ofnebulisers. Patients should be routinely reassessed to determine whether their treatment is effective in improving symptoms and reducing exacerbations.2 Before adjusting a patients therapy, it is important to check their inhaler technique and adherence, and it is essential to consider nonpharmacological interventions such as pulmonary rehabilitation and smoking cessation.2 The algorithm proposed by GOLD requires the clinician to identify the predominant treatable trait (for example, persistent dyspnoea, continuing exacerbations, or both), what therapy the patient is currently receiving and, in some circumstances, blood eosinophil count (see Figure 3).2 The clinician should then use either the left-hand side of the figure if the problem is persisting dyspnoea, or the right-hand side for continuing exacerbations, either in isolation or with persistent dyspnoea. Alternatively, treatment can be switched to LABA/LAMA if there has been a lack of response to ICS treatment, or if ICS side effects warrant discontinuation. A high index of suspicion for COVID-19 needs to be maintained in patients withCOPD who present with symptoms of an exacerbation, especially if accompanied by fever, impaired taste or smell, orgastrointestinal complaints. Supplementary oxygen should be delivered by nasal cannula with a surgical mask to be worn and distancing maintained. Global Initiative for Chronic Obstructive Lung Disease. Following assessment, initial management should address reducing exposure to risk factors, such as smoking cessation, and general advice on healthy living should be provided and any comorbidities managed.2 Patients should also be offered vaccination, including the tetanus, diphtheria, and pertussis vaccine for adults who were not vaccinated in adolescence, and the zoster (shingles) vaccine for adults aged more than 50 years.2 The GOLD 2022 report also includes a new recommendation on ensuring that patients have been vaccinated against COVID-19.2, There have been no significant changes to the discussion of evidence on the effects of pharmacological and nonpharmacological therapies, or to recommendations on the management of stable COPD.2 However, the GOLD 2022 report does comment on the potential benefit of pharmacotherapy in reducing the rate of FEV1 decline.2 The report also discusses further evidence on the benefits of triple therapy with a long-acting beta2 -agonist (LABA)/long-acting muscarinic antagonist (LAMA)/inhaled corticosteroid (ICS), which is associated with reduced mortality compared with LABA/LAMA therapy in symptomatic patients with a history of frequent and/or severe exacerbations.2 In addition, the report explores the evidence that delivering fixed-dose triple-combination therapy in one inhaler may improve patients health status compared with treatment delivery using multiple inhalers.2,8, The recommendations on initial pharmacotherapy for patients in groups AD are unchanged in the GOLD 2022 report.2 Bronchodilators are the recommendedinitial treatment for patients in groups A, B, and C (see Figure 2).2 The choice ofinitial therapy for patients in group D who are symptomatic and at risk of exacerbations depends on the intensity of their symptoms, and may also be influenced by their blood eosinophil count.2, Figure 2: Initial pharmacological treatment2, LAMA=long-acting muscarinic antagonist; LABA=long-acting beta2agonist; ICS=inhaled corticosteroid; eos=blood eosinophil count in cells per microlitre; mMRC=modified British Medical Research Council Breathlessness Score; CAT=COPD Assessment Test. Following several trialsincluding the UK Lung Screening Trial, which showed a significant 20% reduction in lung cancer mortality with a single LDCT14 screening is being piloted in 10 areas around England.15, Evidence and advice surrounding the risk of COVID-19 in people with COPD, the differentiation of an exacerbation of COPD from COVID-19, and the management of COVID-19 in people with COPD has not changed significantly since the 2021 report.2,16,17 The main change in this chapter is a new recommendation on vaccinationevidence suggests that COVID-19 vaccination is highly effective against severe acute respiratory syndrome coronavirus-2 infection requiring hospitalisation, intensive care admission, or an emergency department visit, including in those with chronic respiratory disease.2,18 GOLD advises that patients with COPD should receive COVID-19 vaccination in line with national guidance.2. Global Initiative for Chronic Obstructive Lung Disease. By continuing to use this site, you consent to our use of cookies on this device in accordance with our cookie policy. This website uses cookies to analyse the traffic, to personalise content and ads, and to provide social media features. Rescue short-acting bronchodilators should be prescribed to all patients for immediate symptom relief. Download 2022 GOLD Report. No changes to the management of COVID-19 are required in people with COPD. Systemic steroids should be used in COPD exacerbations according to the usual indications whether or notthere is evidence of SARS-CoV-2 infection, as there is no evidence that this approach modifies the susceptibility toSARS-CoV-2 infection or worsens outcomes. Routine review of patients with COPD can be undertaken remotely. This is a Guidelines summary of the Global Initiative for Chronic Obstructive Lung Diseases 2022global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease report. Chronic and progressive dyspnoea is the most characteristic symptom of COPD, Cough with sputum production is present in up to 30% of patients, These symptoms may vary from day to day and may precede the development of airflow limitation by many years, Individuals, particularly those with COPD risk factors, presenting with these symptoms should be examined to search for the underlying cause(s). Our cookie policy provides further information on what cookies are and how we use them, we have also provided details on where you can find out how to disable and delete cookies on your device. If patients with COPD havebeen exposed to someone with known COVID-19 infection, they should contact their healthcare provider to define theneed for specific testing. In the individual patient, the choice should depend on the patients perception of symptom relief, for patients with severe breathlessness initial therapy with two bronchodilators may be considered, Group B patients are likely to have comorbidities that may add to their symptomatology and impact their prognosis, and these possibilities should be investigated, initial therapy should consist of a single long-acting bronchodilator. Initial pharmacotherapy should be based on the patients GOLD group (AD), which is determined by: level of symptoms (assessed using either CAT or mMRC), number and severity of exacerbations in the past year. Patients with COPD should follow basic infection control measures to help prevent SARS-CoV-2 infection, includingsocial distancing and washing hands, Wearing a tight-fitting N95 mask introduces an additional inspiratory resistance, Whenever possiblepatients should wear masks. By Professor David Halpin2022-02-22T13:01:00+00:00, Professor David Halpin describes key changes in the GOLD 2022 report, and highlights important recommendations for COPD management in primary care, Read this article online at: GinP.co.uk/456774.article.

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