GOLD COPD Guidelines Flashcards

Flashcards based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines for COPD diagnosis, management, and prevention.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease

A document outlining a global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease.

Evidence Category A

Evidence from endpoints of well-designed RCTs that provide consistent findings in the population for which the recommendation is made without any important limitations.

Evidence Category A

Requires high quality evidence from ≥ 2 clinical trials involving a substantial number of subjects, or a single high quality RCT involving substantial numbers of patient without any bias.

Evidence Category B

Evidence is from RCTs that include only a limited number of patients, post hoc or subgroup analyses of RCTs or meta-analyses of RCTs.

Evidence Category C

Evidence is from outcomes of uncontrolled or non-randomized trials or from observational studies.

Evidence Category D

Panel consensus is based on clinical experience or knowledge that does not meet the above stated criteria.

FEV1 Trajectories (TR) Over the Life Course

This encompasses supranormal, normal, pseudonormal, below normal, premature, and accelerated decline lung function.

COPD-G

Genetically determined COPD

COPD-D

COPD due to abnormal lung development

COPD-C

Cigarette smoking COPD

COPD-P

Biomass and pollution exposure COPD

COPD-I

COPD due to infections

COPD-A

COPD and asthma

COPD-U

COPD of unknown cause

Clinical Indicators for Considering a Diagnosis of COPD

Clinical indicators that, if present, suggest the need for spirometry to consider a COPD diagnosis.

Clinical Indicator of COPD

Dyspnea that is progressive over time, worse with exercise and persistent.

Chronic cough

May be intermittent and may be non-productive.

History of risk factors

Tobacco smoke (including popular local preparations), Smoke from home cooking and heating fuels, occupational dusts, vapors, fumes, gases and other chemicals plus Host factors.

Intrathoracic causes of chronic cough

Asthma, Lung Cancer, Tuberculosis, Bronchiectasis, Left Heart Failure, Interstitial Lung Disease and Cystic Fibrosis.

Extrathoracic causes of chronic cough

Chronic Allergic Rhinitis, Post Nasal Drip Syndrome (PNDS), Upper Airway Cough Syndrome (UACS), Gastroesophageal Reflux plus Medication (e.g., ACE Inhibitors).

COPD Suggestive Features

Symptoms slowly progressive and History of tobacco smoking or other risk factors

Asthma Suggestive Features

Variable airflow obstruction and Symptoms vary widely from day to day.

Congestive heart failure Suggestive Features

Chest X-ray shows dilated heart, pulmonary edema and Pulmonary function tests indicate volume restriction, not airflow obstruction.

Bronchiectasis Suggestive Features

Large volumes of purulent sputum and Chest X-ray/HRCT shows bronchial dilation

Tuberculosis Suggestive Features

Chest X-ray shows lung infiltrate and Microbiological confirmation

Obliterative bronchiolitis Suggestive Features

HRCT on expiration shows hypodense areas and Seen after lung or bone marrow transplantation.

Diffuse panbronchiolitis Suggestive Features

Chest X-ray & HRCT show diffuse small centrilobular nodular opacities & hyperinflation.

PREPARATION Considerations in Performing Spirometry

Spirometers should produce hard copy or have a digital display of the expiratory curve to permit detection of technical errors or have an automatic prompt to identify an unsatisfactory test and the reason for it

PERFORMANCE Considerations in Performing Spirometry

The expiratory volume/time traces should be smooth and free from irregularities.

BRONCHODILATION Considerations in Performing Spirometry

Possible dosage protocols are 400 mcg short-acting beta2-agonist, 160 mcg short-acting anticholinergic, or the two combined b; FEV1 should be measured 10-15 minutes after a short-acting beta2-agonist is given, or 30-45 minutes after a short-acting anticholinergic or a combination of both classes of drugs

EVALUATION Considerations in Performing Spirometry

The presence of a post-bronchodilator FEV1/FVC < 0.7 confirms the presence of non-fully reversible airflow obstruction

Spirometry Trace

Graphical representation of lung volume over time during forced expiration, distinguishing between normal airflow and airflow obstruction.

FEV1/FVC ≥ 0.7

Flow response: needs follow-up with repeat assessment.

FEV1/FVC < 0.7

COPD confirmed

Role of Spirometry in COPD

Diagnosis, Assessment of severity of airflow obstruction (for prognosis), Follow-up assessment and Therapeutic decisions.

GOLD 1

Mild: FEV1 ≥ 80% predicted

GOLD 2

Moderate: 50% ≤ FEV1 < 80% predicted

GOLD 3

Severe: 30% ≤ FEV1 < 50% predicted

GOLD 4

Very Severe: FEV1 < 30% predicted

Modified MRC Dyspnea Scale

A scale used to measure breathlessness, ranging from 0 (I only get breathless with strenuous exercise) to 4 (I am too breathless to leave the house)

CAT™ Assessment

A questionnaire used to assess the impact of COPD on a person's life.

GOLD ABE Assessment Tool

A tool that combines spirometric grade, exacerbation history, and symptom assessment to categorize COPD patients.

Use of CT in Stable COPD

Lung Volume Reduction and Lung Cancer Screening

Goals for Treatment of Stable COPD

Relieve Symptoms, Improve Exercise Tolerance, Improve Health Status and Prevent Disease Progression.

Management of COPD

A cyclical process involving initial assessment, review, and adjustment of management strategies.

Identify & Reduce Risk Factor Exposure

Smoking cessation interventions should be actively pursued in all people with COPD.

ASK Brief Strategies to Help the Patient Willing to Quit

Systematically identify all tobacco users at every visit

ADVISE Brief Strategies to Help the Patient Willing to Quit

In a clear, strong, and personalized manner, urge every tobacco user to quit.

ASSESS Brief Strategies to Help the Patient Willing to Quit

Ask every tobacco user if he or she is willing to make a quit attempt at this time

ASSIST Brief Strategies to Help the Patient Willing to Quit

Help the patient with a quit plan; provide practical counseling; provide intra-treatment social support; help the patient obtain extra-treatment social support; recommend use of approved pharmacotherapy except in special circumstances; provide supplementary materials

ARRANGE Brief Strategies to Help the Patient Willing to Quit

Schedule follow-up contact, either in person or via telephone

Treating Tobacco Use and Dependence

Tobacco dependence is a chronic condition that warrants repeated treatment until long-term or permanent abstinence is achieved.

Vaccination for Stable COPD

People with COPD should receive all recommended vaccinations in line with the relevant local guidelines.

GROUP E Initial Pharmacological Treatment

LABA + LAMA, consider LABA+LAMA+ICS if blood eos ≥ 300

GROUP A Initial Pharmacological Treatment

A bronchodilator.

GROUP B Initial Pharmacological Treatment

LABA + LAMA

Management Cycle

A continuous process that involves assessing symptoms, inhaler technique, and non-pharmacological approaches, and then adjusting treatment accordingly.

DYSPNEA Follow-up Pharmacological Treatment

LABA or LAMA, LABA + LAMA*

Key Points for Inhalation of Drugs

When a treatment is given by the inhaled route, the importance of education and training in inhaler device technique cannot be over-emphasized.

Basic Principles for Appropriate Inhalation Device Choice

Availability of the drug in the device, Patients' beliefs, satisfaction with current and previous devices and preferences need to be assessed and considered and The number of different device types should be minimized for each patient.

Non-Pharmacological Management of COPD*

Essential Depending on Patient Group and Smoking cessation

Follow-up of Non-Pharmacological Treatment

If response to initial treatment is appropriate, maintain it and offer: Influenza vaccination every year and other recommended vaccinations according to guidelines, Self-management education plus Assessment of behavioral risk factors such as smoking cessation (if applicable) and environmental exposures.

Oxygen Therapy in Stable COPD

The long-term administration of oxygen increases survival in patients with severe chronic resting arterial hypoxemia

Ventilatory Support in Stable COPD

NPPV may improve hospitalization-free survival in selected patients after recent hospitalization, particularly in those with pronounced daytime persistent hypercapnia (PaCO2 > 53 mmHg)

Prescription of Supplemental Oxygen to COPD Patients

Arterial hypoxemia defined as: PaO2 ≤ 55 mmHg (7.3 kPa) or SaO2 < 88%

Palliative Care, End of Life and Hospice Care in COPD

All clinicians managing patients with COPD should be aware of the effectiveness of palliative approaches to symptom control and use these in their practice

Evidence Supporting a Reduction in Mortality with Pharmacotherapy and Non-pharmacotherapy in COPD Patients

Multiple therapies have been shown to reduce mortality in COPD patients, including LABA+LAMA+ICS, smoking cessation interventions, pulmonary rehabilitation, long-term oxygen therapy, noninvasive positive pressure ventilation, and lung volume reduction surgery.

Maintenance Medications in COPD*

A listing of Maintenance Medications in COPD, including Generic Drug Name, Inhaler Type

Bronchodilators in Stable COPD

Inhaled bronchodilators in COPD are central to symptom management and commonly given on a regular basis to prevent or reduce symptoms

Anti-Inflammatory Therapy in Stable COPD

Regular treatment with ICS increases the risk of pneumonia especially in those with severe disease

Factors to Consider when Initiating Long Term ICS Treatment

History of hospitalization(s) for exacerbations of COPD, ≥ 2 moderate exacerbations of COPD per year, and Blood eosinophils ≥ 300 cells/μL

Management of Patients Currently on LABA+ICS

No current exacerbations with A Previous positive treatment response*

Alpha-1 Antitrypsin Augmentation Therapy

Intravenous augmentation therapy may slow down the progression of emphysema

Pulmonary Rehabilitation

Rehabilitation is indicated in all patients with relevant symptoms and/or a high risk for exacerbation

Education and Self-Management

Education is needed to change patient's knowledge but there is no evidence that used alone it will change patient behavior