Chronic Obstructive Pulmonary Disease (COPD) - Practice Guidelines

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides guidelines for the diagnosis, management, and prevention of COPD. Here are the key points from the GOLD guidelines:

• Spirometry is necessary for the diagnosis of COPD.
• A post-bronchodilator FEV1/FVC <0.7 confirms the presence of persistent airflow limitation.
• Severity is classified based on FEV1 % predicted.

• Non-pharmacological interventions such as smoking cessation, pulmonary rehabilitation, and regular physical activity should be considered in all stages of COPD.
• Pharmacological therapy should be considered in patients with persistent symptoms or exacerbations.
• Inhaled bronchodilators are the mainstay of pharmacological treatment. Long-acting bronchodilators are preferred over short-acting bronchodilators.
• Inhaled corticosteroids should be used in combination with long-acting bronchodilators in patients with severe or very severe COPD and a history of exacerbations.
• Treatment should be stepped up or down based on symptom control and risk of exacerbations.
• Oxygen therapy should be prescribed in patients with chronic respiratory failure and severe resting hypoxemia.
• Surgical interventions such as lung volume reduction surgery and lung transplantation should be considered in selected patients with advanced COPD.

• The primary prevention of COPD is tobacco smoking cessation and the avoidance of exposure to other risk factors.
• Secondary prevention involves identifying patients with COPD at an early stage and implementing appropriate interventions to prevent disease progression and exacerbations.
• Overall, the GOLD guidelines emphasize the importance of individualized care based on symptom severity, exacerbation history, and patient preferences.

BODE Index Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, Pinto Plata V, Cabral HJ. The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease. N Engl J Med. 2004 Mar 04;350(10):1005-12. CAT Assessment Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009 Sep;34(3):648-54. GOLD Singh D, Agusti A, Anzueto A. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019. Eur Respir J. 2019 May;53(5). mMRC Fletcher Cm. Standardized Questionnaires on Respiratory Symptoms. Br Med J. 1960 Dec 3;2(5213):1665.