COPD Grading and Medication Notes

Risk (Airflow Limitation)

Navigating COPD Grading & Medication

Confirm Diagnosis

• Spirometry is used to confirm the diagnosis (0.7 FEV1/FVC).

Assessment

• Assess airflow limitation.

• Assess symptoms and risk of exacerbations.

Assessment of Airflow Limitation

Grade & FEV_1

• GOLD 1: >80% FEV_1

• GOLD 2: 50-79% FEV_1

• GOLD 3: 30-49% FEV_1

• GOLD 4: <30% FEV_1

Assess Symptoms & Exacerbation Risk

mMRC

• Modified Medical Research Council (mMRC) dyspnea scale: 0-4 (severity scale) stratifies severity of dyspnea in COPD.

• mMRC >2 indicates poor health.

CAT

• COPD Assessment Test (CAT) measures the impact of COPD on health using 8 questions (0-5 severity scale).

• CAT >10 indicates poor health.

Number of Exacerbations

• Number of exacerbations or hospital admissions this year is assessed.

• >2 exacerbations or >1 exacerbation with hospitalization are considered.

COPD Grading Scale

COPD Assessment Table

• A: Low Risk, Less Symptoms

  • 0 or 1 exacerbations, mMRC 0-1, CAT <10

  • Treatment: SABA or SAMA PRN (as needed)

• B: Low Risk, More Symptoms

  • 0 or 1 exacerbations, mMRC >2, CAT >10

  • Treatment: LABA/LAMA

• E: High Risk, More Symptoms

  • \geq2 exacerbations or \geq1 with hospitalization, CAT >20, EOS >300

  • Treatment: LAMA or LAMA/LABA or ICS/LABA

COPD Medication Classes

1. Beta Agonists (-TEROL)

• SABA: Short-Acting β_2 Agonist (Albuterol).

• LABA: Long-Acting β_2 Agonist (Formoterol, Indacaterol, Olodaterol).

2. Muscarinic Antagonists (-IUM)

• SAMA: Short-Acting Muscarinic Antagonist (Ipratropium).

• LAMA: Long-Acting Muscarinic Antagonist (Tiotropium).

• Mnemonic: "UM. HAVE COPD FROM SMOKING"

• Caution: SAMA/LAMA have anticholinergic properties (watch with BPH, peptic ulcer disease, & glaucoma).

3. Corticosteroids (-IDE or -SONE)

• ICS: Inhaled Corticosteroids (Beclomethasone, Budesonide, Fluticasone).

• Remember that C comes before T.