GOLD guidelines providing recommendations for the management of COPD

Chronic lung disease (COPD) is a common preventable disease characterized by airflow limitation and persistent respiratory symptoms.

Respiratory symptoms include cough, dyspnea, and sputum production, and patients may experience brief episodes of acute exacerbation of respiratory symptoms known as exacerbations. COPD is commonly associated with significant concomitant chronic illness that increases morbidity and mortality.¹

COPD affects approximately 1 in 10 people worldwide and its prevalence is increasing daily. The highest associated mortality rates are in China, India, Latin America, Southeast Asia, and sub-Saharan Africa. Air pollution, indoor and outdoor smoke, and smoking are major risk factors for COPD, and although many risk factors may predispose her to COPD, the disease is still underdiagnosed. Further emphasis should be placed on risk factor identification and screening to improve diagnosis, which is expected to improve disease progression.²

The Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) Guidelines provides recommendations for the diagnosis, management, and prevention of COPD. New recommendations for the 2022 update¹ It is relevant for pharmacological management and pulmonary rehabilitation of COPD.

Pulmonary rehabilitation is outlined in the GOLD guidelines as a patient-assessed, comprehensive intervention and individualized for each patient. This includes education, exercise training, and self-management aimed at eliciting behavioral changes to improve management of chronic respiratory disease. Pulmonary rehabilitation improves dyspnea, exercise tolerance, well-being, and reduces anxiety and depression in people with COPD. Pulmonary rehabilitation has also been shown to reduce hospitalization in patients who have deteriorated within 4 weeks of a previous hospitalization. From a self-management perspective, communication with a healthcare professional is recommended to reduce emergency department visits.

One of the key new findings in the updated guidelines was an increased risk of respiratory disease among existing and former e-cigarette users. This was true even after adjusting for factors such as chronic health conditions, tobacco and other combustible tobacco product use. , and demographics.It is derived from a large prospective cohort study³ We have treated over 20,000 patients in 5 years. The guidelines recommend annual low-dose computed tomography scans to evaluate smoking-related lung cancer in her COPD patient. Another recent non-pharmacological control strategy includes shielding measures such as frequent hand washing, wearing masks, and minimizing social contact in winter to reduce exacerbations. These measures have been commonly used by many individuals with and without COPD during the COVID-19 pandemic. This may have prompted the idea that these measures could be particularly helpful for her COPD patients.

Another way the COVID-19 pandemic has influenced the guidelines is that they have been updated to recommend COVID-19 vaccination for COPD patients in line with national recommendations.^Four The guidelines also newly recommend the shingles vaccine to protect adults with COPD over the age of 50 from shingles. Other recommended vaccinations previously mentioned in the 2021 edition^Five Includes influenza, whooping cough (Tdap and dTaP), and pneumonia (PCV13 and PPSV23).

The guidelines also describe the use of theophylline in the management of COPD.Theophylline is a methylxanthine and may act as a non-selective phosphodiesterase inhibitor, although a variety of non-bronchodilators have been reported and the significance of the effect is debated. There is evidence that theophylline has a modest bronchodilatory effect compared to placebo in COPD, but the guidelines refer to large placebo-controlled trials.⁶ Oral theophylline alone or in combination with 5 mg of prednisolone daily was shown to have no effect on severe COPD exacerbations.

Pharmacological treatments for COPD also include inhaled corticosteroids (ICS), long-acting beta2-agonists (LABAs), and long-acting muscarinic antagonists (LAMAs). They can be used individually or in various combinations depending on the course of COPD. The simultaneous use of all three drugs is known as triple therapy and is recommended for patients who continue to have exacerbations or symptoms while on his dual therapy regimen of LABA/LAMA or ICS/LABA. .in large randomized trials⁷ A study of the efficacy and safety of triple therapy at two dose levels in patients receiving ICS therapy with moderate-to-very-severe COPD and at least one exacerbation in the past year. Dose-inclusive triple therapy (ICS/LABA/LAMA) ICS led to lower mortality compared with dual therapy (LABA/LAMA).

Considering the effect of global pharmacotherapy in COPD on slowing the rate of decline in forced expiratory volume (FEV1), the guideline refers to a systematic review.⁸ Of the 9 studies that showed a 5.0 mL/year reduction in FEV1 decline in the active group compared with the placebo group. This review specifically found a difference of 7.3 mL/year for inhaled cortocosteroids and 4.9 mL/year for long-acting bronchodilators, although it is unclear which specific patients benefit. Further research is needed to know.

Conclusion

The GOLD guidelines are a vital resource available to clinicians to improve diagnosis, management, and prevention of COPD. The COVID-19 pandemic has clearly contributed to changes in the 2022 guideline update, and the course of this pandemic, and the emergence of other epidemics in the future, will further change clinicians’ approaches to managing COPD. There is a possibility. The fact that COPD is now one of the top three causes of death worldwide further underscores the need for clinicians to stay up to date with evidence-based recommendations for diagnosing, managing, and preventing her COPD. I am emphasizing.

References

1. 2022 GOLD Report. Global Initiative for Chronic Obstructive Pulmonary Disease. Accessed October 24, 2022. https://goldcopd.org/2022-gold-reports-2/

2. Halpin DMG, Vogelmeier CF, Agusti A. Lung health for all: chronic obstructive pulmonary disease and World Lung Day 2022. Am J Respir Crit Care Med. 2022;206(6):669-671 doi:10.1164/rccm.202207-1407ED

3. Xie W, Kathuria H, Galiatsatos P, et al. Associations between e-cigarette use and respiratory symptoms in US adults from 2013 to 2018. JAMA Netw Open. 2020;3(11):e2020816.doi:10.1001/worldnetworks.2020.20816

4. Thompson MG, Stenehjem E, Grannis S, et al. Efficacy of COVID-19 vaccines in outpatient and inpatient care settings. N Engl J Med. 2021;385(15):1355-1371. doi:10.1056/NEJMoa2110362

5. Halpin D. GOLD COPD Strategy: What’s New for 2021? Actual Guidelines. February 24, 2021. Accessed October 24, 2022.

6. Jenkins CR, Weng FQ, Martin A, et al. Effect of low-dose corticosteroids and theophylline on the risk of acute exacerbations in COPD: a TASCS randomized controlled trial. Eur Respir J. 2021;57(6):2003338. doi:10.1183/13993003.03338-2020

7. Rabe KF, Martinez FJ, Ferguson GT, et al. Three inhaled glucocorticoid doses in moderate to severe COPD. N Engl J Med. 2020;383(1):35-48. doi:10.1056/NEJMoa1916046

8. Celli BR, Anderson JA, Cowans NJ, et al. Drug therapy and decreased lung function in patients with chronic obstructive pulmonary disease. Systematic review. Am J Respir Crit Care Med. 2021;203(6):689-698. doi:10.1164/rccm.202005-1854OC