The GOLD guidelines for COPD was initiated to achieve an effective pharmacotherapy,delay the progression of disease, prevent the occurrence of exacerbations and obtain a better patient. In two head-to-head comparisons the tested long-acting muscarinic antagonist (LAMA) was superior to the long-acting beta, in general, therapy can be started with a LAMA as it has effects on both breathlessness and exacerbations, for patients with more severe symptoms (order of magnitude of CAT 20 or greater), especially driven by greater dyspnoea and/or exercise limitation, LABA/LAMA may be chosen as initial treatment, in some patients, initial therapy with LABA/inhaled corticosteroid (ICS) may be the first choice; this treatment has the greatest likelihood of reducing exacerbations in patients with blood eosinophil counts of 300cells per microlitre or greater. The risks of nebulised therapy spreading infection to other people in patients homes may beminimised by avoiding use in the presence of other people, and ensuring that the nebuliser is used near open windowsor in areas of increased air circulation. 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. 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. 2022 GOLD Reports - Global Initiative for Chronic Obstructive Lung ICS may cause side-effects such as pneumonia, so should be used as initial therapy only after the possible clinical benefits versus risks have been considered. Antibody testing may be used to support clinical assessment of patients who present late. [1] Recommendations by the GOLD Committees for use of any medication are based on the best evidence available from the published literature and not on labeling directives from government regulators. 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. 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. If patients with COPDare asked to shield it is important that they are given advice about keeping active and exercising as much as possiblewhilst shielded. The report recommends using blood eosinophil count as a circulating biomarker to help guide treatment choices to maximise the benefit and minimise the risk of using ICS therapy. Krist A, Davidson K, Mangione C et al. 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. In patients with very severe COPD (progressive disease, Body-mass index, airflow Obstruction, Dyspnea, and Exercise score of 7 to 10, and not candidate for lung volume reduction), lung transplantation may be considered for referral with at least one of the following: history of hospitalisation for exacerbation associated with acute hypercapnia (partial pressure of carbon dioxide over 50 mmHg), pulmonary hypertension and/or cor pulmonae, despite oxygen therapy, or, An exacerbation of COPD is defined as an acute worsening of respiratory symptoms that results in additional therapy, As the symptoms are not specific to COPD, relevant differential diagnoses should be considered, Exacerbations of COPD can be precipitated by several factors. 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. Global Initiative for Chronic Obstructive Lung Disease - Global . Palliative approaches are effective in controlling symptoms in advanced COPD. Finally, their history of moderate and severe exacerbations (including prior hospitalisations) should be recorded, The number provides information regarding severity of airflow limitation (spirometric grade 14) while the letter (groups AD) provides information regarding symptom burden and risk of exacerbation, which can be used to guide therapy, Example: Consider two patientsboth patients with FEV. 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. Following an exacerbation, appropriate measures for exacerbation prevention should be initiated. Consider COPD, and perform spirometry, if any of these indicators are present in an individual over age 40. PDF Global Initiative for Chronic Obstructive Lung Disease - Global 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. By continuing to use this site, you consent to our use of cookies on this device in accordance with our cookie policy. The follow-up pharmacological treatment algorithm (see Algorithm 4) can be applied to any patient who is already taking maintenance treatment(s) irrespective of the GOLD group allocated at treatment initiation. The GOLD 2022 report is available on the GOLD website (www.goldcopd.org), which has been updated with links to patient information. 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. 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. GLOBAL STRATEGY FOR PREVENTION, DIAGNOSIS AND MANAGEMENT OF COPD: 2022 Report. Global strategy for the diagnosis, management, and prevention of chronicobstructive pulmonary disease2022 report. Caution has been raised about the widespread use of systemic corticosteroids in patients with COVID-19. 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. 2022 GOLD Reports - Global Initiative for Chronic Obstructive Lung Spirometry is required to establish a diagnosis of COPD: may be intermittent and may be unproductive, any pattern of chronic sputum production may indicate COPD, recurrent lower respiratory tract infections, host factors (such as genetic factors, congenital/developmental abnormalities, etc), tobacco smoke (including popular local preparations), smoke from home cooking and heating fuels, occupational dusts, vapours, fumes, gases, and other chemicals. all Group A patients should be offered bronchodilator treatment based on its effect on breathlessness. 2022 GOLD TEACHING SLIDE SET PowerPoint slide set summarizing GOLD's objectives, documents, and management recommendations from the 2022 update of the GOLD Report, with background information about COPD and the burden of this disease. Reporting forms and information can be found atwww.mhra.gov.uk/yellowcard. 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. Rescue short-acting bronchodilators should be prescribed to all patients for immediate symptom relief. Field J, Vulkan D, Davies M et al. Whilst case rates are high, centre-based rehabilitation is not appropriate. A diagnosis of COPD is based on the presence of symptoms and airflow obstruction, which is demonstrated by a postbronchodilator forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio of less than 0.7 on spirometry.2 The goals of assessment are to determine the level of airflow limitation, the impact of the disease on the patients health, and the risk of future events, such as exacerbations, hospital admissions, or death. 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. In the absence of subgroup data, GOLD recommends that COPD patients suffering with COVID-19 should be treated withthe same standard of care treatments as other COVID-19 patients. See Algorithm 2 for an overview of initial pharmacological treatment. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Theprodrome of milder symptoms is especially problematic in patients with underlying COPD who may already havediminished lung reserve. 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. In patients with a forced expiratory volume in one second (FEV, In the revised assessment scheme (see Algorithm 1), patients should undergo spirometry to determine the severity of airflow limitation (that is, spirometric grade). View this summary online at guidelines.co.uk/455088.article. The British Lung Foundation also provides useful information for patients in the UK (www.blf.org.uk). the presence and severity of the spirometric abnormality, the current nature and magnitude of the patients symptoms, history of moderate and severe exacerbations, and future risk, COPD remains an important cause of morbidity and mortality during the COVID-19 pandemic, A diagnosis of COPD should be confirmed with a postbronchodilator spirometry test showing a FEV, Diagnostic spirometry should be performed in accordance with infection control guidance. Reproduced with permission. These patient symptoms should be used to help develop appropriate interventions. Duration of therapy should be 57days, Methylxanthines are not recommended due to increased side-effect profiles, Non-invasive mechanical ventilation should be the first mode of ventilation used in COPD patients with acute respiratory failure who have no absolute contraindication because it improves gas exchange, reduces work of breathing and the need for intubation, decreases hospitalisation duration, and improves survival. adjust pharmacological treatment, including escalation or de-escalation. Diagnostic spirometry in primary care has been severely disrupted by the pandemic, but it is slowly being restarted following joint guidance from the British Thoracic Society, the Association for Respiratory Technology and Physiology, and the Primary Care Respiratory Society.7 Spirometry is not considered to be an aerosol-generating procedure; however, performing spirometry often induces a cough. Routine review of patients with COPD can be undertaken remotely. This summary includes information on the diagnosis, assessment, and management of stable chronic obstructive pulmonary disease (COPD), management of exacerbations, and COPD and comorbidities. View list of references for the 2021 Pocket Guide. During the COVID-19 pandemic patients with COPD should continue with their non-pharmacological therapy. Available at: www.goldcopd.org Reproduced with permission. In the absence of specific studies, these general considerations would also apply to COPD patients infectedwith SARS-CoV-2. Supplementary oxygen should be delivered by nasal cannula with a surgical mask to be worn and distancing maintained. For further recommendations, download the full GOLD strategy for COPD: Global strategy for diagnosis, management and prevention of COPD 2022, Pocket guide to COPD diagnosis, management and prevention 2022. Reflection is important for continuous learning and development, and a critical part of the revalidation process for healthcare professionals. When COPD is part of a multimorbidity care plan, attention should be directed to ensure simplicity of treatment and to minimise polypharmacy. Physical activity is a strong predictor of mortality. Following review of the patient response to treatment initiation, adjustments in pharmacological treatment may be needed. Evidence-based strategy document for COPD diagnosis, management, and prevention, with citations from the scientific literature. Legislative smoking bans and counselling, delivered by healthcare professionals, improve quit rates, The effectiveness and safety of e-cigarettes as a smoking cessation aid is uncertain at present, Pharmacological therapy can reduce COPD symptoms, reduce the frequency and severity of exacerbations, and improve health status and exercise tolerance. The Committee does not make recommendations for therapies that have not been approved by at least one major regulatory agency. Antibiotics should be used in COPD exacerbations according to the usual indications whether or not thereis evidence of SARS-CoV-2 infection, particularly as patients with COPD who develop COVID-19 are reported to morefrequently develop bacterial or fungal co-infections. 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. GOLD, 2022. 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. LABA/ICS may also be first choice in COPD patients with a history of asthma. Significant airflow limitation may also be present without chronic dyspnoea and/or cough and sputum production and vice/versa. Not included in this summary are recommendations on medical history, considerations in performing spirometry, assessment of symptoms and exacerbation risk, smoking cessation, prescribing supplemental oxygen to COPD patients, interventional bronchoscopic and surgical treatments for COPD, and monitoring and follow-up post-surgery. Following implementation of therapy, patients should be reassessed for attainment of treatment goals and identification of any barriers for successful treatment (seeAlgorithm3). They should also undergo assessment of either dyspnoea using the modified Medical Research Council questionnaire, or symptoms using COPD assessment test (CAT). 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. This summary includes information on the diagnosis, assessment, and management of stable chronic obstructive pulmonary disease (COPD), management of exacerbations, and COPD and comorbidities. Refer to Table 1 for a list of differential diagnoses. Bafadhel M, Peterson S, De Blas M et al. Halpin D, Worsley S, Ismaila A et al. Pharmacotherapy and nicotine replacement reliably increase long-term smoking abstinence rates. This formulary decision guide was developed from content provided by Teva UK Limited in a format developed by Guidelines in Practice.Viewprescribing information and adverse event reporting information hereAdverse events should be reported. This website uses cookies to analyse the traffic, to personalise content and ads, and to provide social media features. However, individual patient factors may be considered when evaluating the patients needs for supplemental oxygen. Patients with a high symptom burden and a risk of exacerbations (those in groups B, C, and D) should be encouraged to take part in a structured pulmonary rehabilitation programme that takes into account the individuals characteristics and comorbidities.2 The report highlights that patients who are older, female, more deprived, and those who have a comorbidity including diabetes, asthma, or a painful condition, are less likely to be referred for pulmonary rehabilitation, and recommends that this should be addressed.2 For the first time, the report also includes a section on tele-rehabilitation, which recommends that tele-rehabilitation is safe and has similar benefits to those of centre-based pulmonary rehabilitation.2 However, it emphasises that the evidence base is still evolving, and that best practice in delivering tele-rehabilitation and remotely assessing patients has not yet been established.2 Nevertheless, tele-rehabilitation offers a way of delivering rehabilitation during the pandemic.2, Malnutrition in COPD impairs lung function, and is associated with poor exercise tolerance, worsened quality of life, and increased hospitalisations and mortality.2 The nutritional support section of the report has been updated to reflect recent evidence that multimodality treatment combining rehabilitation with nutritional support and protein supplementation may improve fat-free mass, body mass index, and exercise performance.2, Lung cancer is frequently seen in patients with COPD, and is a major cause of death.2 The GOLD 2022 report describes a new recommendation from the United States Preventive Services Task Force that patients with COPD aged 5080 years with a 20 pack-year smoking history (smoking one pack per day for 20 years) who currently smoke, or who have quit smoking within the past 15 years, should have an annual low-dose computed tomography scan (LDCT) for lung cancer screening.12 This does not fit with current guidance in the UK, as the UK National Screening Committee does not recommend screening for lung cancer,13 but this may change. The need to treat primarily dyspnoea/exercise limitation or prevent exacerbations further should be evaluated. By continuing to use this site, you consent to our use of cookies on this device in accordance with our cookie policy. 2022 GOLD Reports - Global Initiative for Chronic Obstructive Lung Halpin D, Criner G, Papi A et al. The aim of the awareness event was to highlight that, even during the pandemic, COPD remains a leading cause of death worldwide, and to emphasise the importance of maintaining healthy lungs.4, The pandemic has undoubtedly made the diagnosis and routine management of COPD more difficult, but it has also led to insights that may have long-term benefits for patients with COPD. 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. GOLD COPD 2022 strategy | Independent professional body - Guidelines Global Initiative for Chronic Obstructive Lung Disease. Importantly, there are no known druginteractions between remdesivir and inhaled COPD treatments. Long-acting inhaled bronchodilators are superior to short-acting bronchodilators taken as needed, that is, pro re nata (prn), and are therefore recommended, there is no evidence to recommend one class of long-acting bronchodilators over another for initial relief of symptoms in this group of patients. 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. Adverse events should also be reported to Teva UK Limited on 0207 540 7117 or medinfo@tevauk.com DUOR-GB-00148Date of preparation: August 2022, Dr Mark L Levy explores the updated recommendations of the 2022 Global Initiative for Asthma strategy on the management and prevention of asthma, Jane E Scullion provides 11 top tips to help primary care empower adult patients to achieve optimal asthma control, Dr Mark L Levy highlights updated recommendations on asthma management from the 2021 Global Initiative for Asthma report, DrKevin Gruffydd-Jones identifies six key learning points for primary care from theBritish Thoracic Society guideline on bronchiectasis, This site is intended for UK healthcare professionals, A. Menarini Farmaceutica Internazionale SRL Resource Hub, www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/monthlymortalityanalysisenglandandwales/december2021, www.brit-thoracic.org.uk/covid-19/covid-19-resumption-and-continuation-of-respiratory-services/#restarting-spirometry, view-health-screening-recommendations.service.gov.uk/lung-cancer/, Top tips: managing asthma in children and adults, DuoResp Spiromax (budesonide/formoterol) inhalation powder, Viewprescribing information and adverse event reporting information here, Gain effective control of mild asthma to avoid fatal exacerbations, Top tips: diagnosing and managing asthma in adults. Corticosteroids in patients with COPD can be undertaken remotely the Committee does not make recommendations for therapies have! Supplemental oxygen measures for exacerbation prevention should be prescribed to all patients for immediate symptom relief prevention, diagnosis management! 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