GOLD COPD strategy: what’s new for 2021? (2022)

Professor David Halpin describes the key updates in the 2021 GOLD COPD report and highlights new recommendations about patients with COPD and COVID-19

Read this article to learn more about:

GOLD COPD strategy: what’s new for 2021? (1)

Professor David Halpin

  • diagnosing and assessing chronic obstructive pulmonary disease (COPD)
  • recent evidence about the role of triple therapy in COPD
  • the impact of COVID-19 on people with COPD.

Implementation actions for STPs and ICSs

Read this article at: GinP/455824.article

In November 2020, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) committee published its 2021 report,Global strategy for the diagnosis, management, and prevention of COPD.1 The report contains recommendations on the diagnosis and assessment of people with chronic obstructive pulmonary disease (COPD), the management of stable disease and exacerbations, and the role of co-morbidities. The 2021 report contains some small but important updates to these recommendations, but the most significant change is the inclusion of a new chapter on COPD and COVID-19.2

In 2018, GOLD held a 1-day summit to consider information about the epidemiology, clinical features, approaches to prevention and control, and the availability of resources for COPD in low and middle income countries (LMICs).3 The GOLD 2021 report begins to take account of the conclusions of the summit by incorporating references to the World Health Organization minimum set of interventions for the diagnosis and management of COPD, but it also highlights that there remains much to be done to improve outcomes in LMICs, including:1

  • there are limited data about the epidemiological and clinical features of COPD in these countries
  • diagnostic spirometry services are not widely available
  • there are major problems with access to affordable quality-assured pharmacological and non-pharmacological therapies.

The 2021 report also emphasises that COPD is still not being taken seriously enough at any level—from individuals and communities to national governments and international agencies—and it is time for this to change.1,4

Diagnosis and assessment of people with COPD

The 2021 GOLD report continues to recommend that a diagnosis of COPD is based on the presence of symptoms and airflow obstruction demonstrated by a postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio of less than 0.7 on spirometry. It states: ‘The goals of assessment are to determine the level of airflow limitation, the impact of the disease on the patient’s health status, and the risk of future events (such as exacerbations, hospital admissions, or death)’.1 To achieve these goals, the report recommends that assessment of people with COPD must separately consider the following aspects of the disease:1

  • the presence of the spirometric abnormality and its severity
  • current nature and magnitude of symptoms
  • history of moderate and severe exacerbations and future risk
  • presence of co-morbidities.

The degree of FEV1 impairment, expressed as a percentage of the predicted value, is used to determine the GOLD stage (1–4),1 but the level of symptoms, as determined by the modified MRC breathlessness score (mMRC) or the COPD assessment test (CAT) and the risk of exacerbations, based on the number of moderate or severe exacerbations in the previous year, are used to determine the patient’s GOLD group (see Figure 1).1 The GOLD 2021 report again emphasises that this assessment of symptoms and risk of exacerbations is recommended only as a basis for determining initial therapy and is not designed for reassessing patients during follow up.1

GOLD COPD strategy: what’s new for 2021? (2)

(Video) COPD GOLD Quick Review | 2020 update | DocDJShah

Figure 1: The refined ABCD assessment tool1

FEV1 =forced expiratory volume in 1 second; FVC=forced vital capacity; GOLD=Global Initiative for Chronic Obstructive Lung Disease; mMRC=modified British Medical Research Council; CAT=COPD assessment test

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD, 2021. Available at: www.goldcopd.org

Reproduced with permission

Initial management

Following assessment, initial management should address reducing exposure to risk factors, such as smoking cessation, general advice on healthy living and the patient’s co-morbidities should be provided, and vaccination offered (see Figure 2).1 The GOLD 2021 report now includes the recommendation from the US Centers for Disease Control that tetanus, diphtheria, and pertussis (TdaP) vaccination should be offered to adults with COPD who were not vaccinated in adolescence to protect against pertussis.1

GOLD COPD strategy: what’s new for 2021? (3)

Figure 2: Management of COPD1

FEV1 =forced expiratory volume in 1 second; GOLD=Global Initiative for Chronic Obstructive Lung Disease; CAT=COPD assessment test; mMRC=modified British Medical Research Council; NIV=non-invasive ventilation

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD, 2021. Available at:www.goldcopd.org

Reproduced with permission

Recommendations on pharmacotherapy

The GOLD 2021 report continues to separate recommendations for initial therapy from those on escalation or de-escalation of therapy based on changes in the patient’s breathlessness or exacerbation frequency.

(Video) COPD guidelines GOLD 2021 Read aloud Part 2

Blood eosinophil counts

The report continues to recommend using the blood eosinophil count as a circulating biomarker to help guide treatment choices to maximise benefit and minimise risk of using inhaled corticosteroid (ICS) therapy. Recent prospective clinical trials have shown that higher blood eosinophil counts are predictive of the efficacy of ICS in reducing exacerbations whereas observational studies show low counts are predictive of an increased risk of developing pneumonia.1 The relationships between the blood eosinophil count and the likelihood of benefit or risk of harm are continuous,1,5,6 but thresholds that can be used as guides in clinical practice are recommended by GOLD.1

Initial pharmacotherapy

Figure 3 shows the recommended initial pharmacotherapy for patients in groups A to D, which is unchanged from the 2020 report.1 Bronchodilators are the recommended initial treatment for patients in groups A, B, and C. The choice of initial therapy for patients in group D who are symptomatic and at risk of exacerbations depends on the intensity of symptoms and may also be influenced by the blood eosinophil count.

GOLD COPD strategy: what’s new for 2021? (4)

Figure 3: Initial pharmacological therapy1

LAMA=long-acting muscarinic antagonist; LABA=long-acting beta2‑agonist; ICS=inhaled corticosteroid; eos=blood eosinophil count in cells per microlitre; mMRC=modified British Medical Research Council; CAT=COPD assessment test

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD, 2021. Available at:www.goldcopd.org

Reproduced with permission

Patient review and treatment reassessment

Patients should be reassessed to determine whether the treatment goals of reducing the risk of exacerbations or reducing breathlessness and improving exercise capacity have been achieved and if not whether there are any correctable barriers to successful treatment, such as poor inhaler technique or poor adherence (see Figure 2).1 At this review it is also essential to consider non-pharmacological interventions such as pulmonary rehabilitation and smoking cessation. If the response to the initial therapy is sufficient the treatment should be continued, but if the patient is continuing to have problems despite the initial therapy the treatment should be modified.1

The algorithm proposed by GOLD requires the clinician to identify what the predominant treatable trait is (i.e. persistent dyspnoea, continuing exacerbations, or both) and what therapy the patient is currently receiving (see Figure 4).1 The clinician should then use either the left-hand side of the figure if the problem is persisting dyspnoea or the right-hand side if it is continuing exacerbations either in isolation or with persistent dyspnoea.

GOLD COPD strategy: what’s new for 2021? (5)

Figure 4: Recommended pathways for escalating and de-escalating therapy depending on the current therapy and treatable trait1

(Video) GOLD 2021 teaching slide part 1

LABA=long-acting beta2‑agonist; LAMA=long-acting muscarinic antagonist; ICS=inhaled corticosteroid; eos=blood eosinophil count in cells per microlitre; FEV1 =forced expiratory volume in 1 second

Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD, 2021. Available at:www.goldcopd.org

Reproduced with permission

Triple therapy

The GOLD 2021 report contains an updated assessment of the benefits of triple therapy withlong-acting beta2‑agonist(LABA)/long-acting muscarinic antagonist (LAMA)/ICS based on the results of recent large randomised controlled trials. Triple therapy has been shown to improve lung function, patient reported outcomes and reduce exacerbations when compared with LAMA alone, LABA/LAMA, and LABA/ICS .7–17

Two large 1-year randomised controlled trials—IMPACT (n=10,355) and ETHOS (n=8509)—provide new evidence on mortality reduction with fixed-dose inhaled triple-therapy combinations compared with dual therapy.8,18 Both trials were enriched for symptomatic patients with a history of frequent and/or severe exacerbations and compared a triple therapy (at two ICS dosages in ETHOS) to two dual therapy options (LABA/LAMA and LABA/ICS). Mortality was a pre-specified outcome for the trials, but not a primary endpoint for either study. In IMPACT, mortality in the triple therapy arm was significantly lower compared with the dual bronchodilation arm19 with similar findings observed in ETHOS with the higher dose ICS (but not the lower dose).20 The GOLD 2021 report concludes that these results suggest triple therapy has a beneficial effect on mortality in symptomatic patients with a history of frequent and/or severe exacerbations.1 It also states that further analyses or studies may help determine whether other specific patient subgroups demonstrate a greater survival benefit.1

COPD and COVID-19

The COVID-19 pandemic has led to many challenges for the routine management and diagnosis of COPD, as well as concerns about outcomes for patients.1 The GOLD 2021 report reviews the current evidence about COPD and COVID-19 and makes provisional recommendations based on the current state of knowledge.1 It concludes that, based on current evidence, patients with COPD do not seem to be at greatly increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), possibly reflecting the effect of protective strategies.1 Patients with COPD are at a slightly increased risk of hospitalisation for COVID-19, but the evidence about the risk of developing severe disease and death are contradictory.1 Overall, the magnitude of these risks is lower than might be expected.

The GOLD 2021 report recommends that patients with COPD should follow basic infection control measures to help prevent SARS-CoV-2 infection, including social distancing and washing hands, and whenever possible they should wear masks.1 In most cases, as highlighted in studies about use in the general population, a loose face covering or even a face shield may be tolerable and effective,1,21,22 and wearing a surgical mask does not appear to affect ventilation even in patients with severe airflow limitation.1,23

Many health systems have reduced face-to-face visits during the pandemic and introduced remote consultations using phone and online video calls. A tool is available on the GOLD website to support remote review of COPD patients. The GOLD 2021 report recommends that spirometry should be restricted to urgent or essential situations only, such as prior to interventional procedures or surgery.1 It suggests that when routine spirometry is not available, home measurement of peak expiratory flow (PEF) combined with validated patient questionnaires can be used to support or refute a possible diagnosis of COPD.1 It does, however, point out that PEF does not correlate well with the results of spirometry,24–26 has low specificity,27 and cannot differentiate obstructive and restrictive lung-function abnormalities.1

The use of ICS in the treatment of COPD during the COVID-19 pandemic has been questioned; although it has an overall protective effect against exacerbations in patients with COPD and a history of exacerbations, ICS use is also associated with an increased risk of pneumonia.1 A systematic review identified no clinical studies in patients with COPD concerning the relationship between ICS use and clinical outcomes with coronavirus infections.28 A more recent study suggested ICS use in COPD was not protective against coronavirus infection and raised the possibility that it increased the risk of developing COVID-19,29 but the results are likely to be confounded by the indication for ICS.30 The GOLD 2021 report concludes that there are no conclusive data to support alteration of maintenance COPD pharmacological treatment, including ICS, either to reduce the risk of developing COVID-19, or conversely because of concerns that pharmacological treatment may increase the risk of developing COVID-19 (Figure 5).1

GOLD COPD strategy: what’s new for 2021? (6)

Figure 5:COPD and SARS-CoV-2 infection: clinical features, abnormal investigations, and possible interventions at different stages of the disease2

COPD=chronic obstructive pulmonary disease; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2; ARDS=acute respiratory distress syndrome; SOB=shortness of breath; PaO2=partial pressure of oxygen; FiO2=fraction of inspired oxygen; SIRS=systemic inflammatory response syndrome; VTE=venous thromboembolism; PCR=polymerase chain reaction; CXR=chest radiograph; CT=computed tomography; SpO2=peripheral oxygen saturation; PCT=procalcitonin; CRP=C-reactive protein; LDH=lactate dehydrogenase; IL-6=interleukin-6; BNP=brain natriuretic peptide; PFT=pulmonary function tests; NIV=non-invasive ventilation; HFNT=high-flow nasal therapy; IMV=invasive mechanical ventilation; PR=pulmonary rehabilitation

Reprinted with permission of the American Thoracic Society.Copyright © 2021 American Thoracic Society. All rights reserved.Halpin D, Criner G, Papi A et al. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and chronic obstructive pulmonary disease.Am J Respir Crit Care Med 2021; 203 (1): 24–36.The American Journal of Respiratory and Critical Care Medicine is an official journal of the American Thoracic Society.

(Video) What's changed in COPD? GOLD 2021 Updates | Covid 19 and COPD - Dr. Raja Dhar, Pulmonology

To reduce risks of spreading SARS-CoV-2, many pulmonary rehabilitation programmes have been suspended during the pandemic. The GOLD 2021 report recommends that patients should be encouraged to keep active at home and supported by home-based rehabilitation programmes.1

As highlighted by GOLD, differentiating the symptoms of COVID-19 infection from the usual symptoms of COPD or an exacerbation can be challenging: ‘Cough and breathlessness are found in over 60% of patients with COVID-19, but are usually also accompanied by fever (>60% of patients) as well as fatigue, confusion, diarrhoea, nausea, vomiting, muscle aches and pains, anosmia, dysgeusia, and headaches.’1 These additional symptoms may suggest a diagnosis of COVID-1931 and testing for SARS-CoV-2 should be considered. Detection of SARS-CoV-2 does not exclude the potential for co-infection with other respiratory pathogens and testing for other causes of respiratory illness is also recommended.32

Chest radiography is indicated in patients with COPD with moderate to severe symptoms of COVID-19,1 with mostly bilateral changes seen with COVID-19 pneumonia.1,33 Alternative diagnoses, such as lobar pneumonia, pneumothorax, or pleural effusion, can also be excluded or confirmed with chest radiography. Patients with COVID-19 are at increased risk of venous thromboembolism34–37 and computed tomography pulmonary angiography should be performed if pulmonary embolism is suspected.1

Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications.1 Patients with COPD who are hospitalised with moderate to severe COVID-19 and pneumonia should be treated with the evolving pharmacotherapeutic approaches, as appropriate, such as dexamethasone and anticoagulation to prevent venous thromboembolism.1 Management of acute respiratory failure should include appropriate oxygen supplementation, prone positioning, high-flow nasal oxygen, non-invasive ventilation, and invasive mechanical ventilation if indicated.1

The report recommends that rehabilitation should be provided to all COPD patients recovering from COVID-19. Patients who develop mild COVID-19 should be followed up as usual, but those with moderate or severe COVID-19 should be monitored more frequently, particularly with regard to their need for oxygen therapy.1

Summary

The GOLD 2021 report does not make any major changes to the recommendations for the diagnosis and assessment of COPD nor for the management of stable disease or exacerbations. The new chapter on COPD and COVID-19 recommends that there is no need to change the pharmacological and non-pharmacological management of stable COPD, but if patients have symptoms of an exacerbation or suggestive of COVID-19 they should be tested for SARS-CoV-2 infection and managed accordingly.

Professor David Halpin

Consultant Physician and Honorary Professor of Respiratory Medicine, University of Exeter Medical School

Member of the GOLD Board of Directors and Science Committee

Key points

  • There were no significant changes to the recommendations on management of COPD, including pharmacotherapy, in the 2021 update to the GOLD report
  • Multidimensional assessment of COPD based on spirometry, symptoms, exacerbation risk, and presence of co-morbidities remains essential
  • There is a new recommendation that the TdaP vaccination should be offered to patients with COPD who were not vaccinated in adolescence to protect against pertussis
  • Initial therapy is based on the patient’s GOLD group and includes non-pharmacological as well as pharmacological approaches
  • After maintenance therapy has been prescribed, patients should be reviewed to determine their response. The review should include assessment of inhaler technique and compliance
  • Patients who remain breathless or who continue to experience exacerbations should have their therapy escalated with the new therapy being determined by both what their current therapy is and the trait requiring treatment
  • Long-acting bronchodilators remain the mainstay of pharmacotherapy
  • It is recommended that the use of ICS is guided by the blood eosinophil count
  • The pharmacological and non-pharmacological management of stable COPD does not need to change during the coronavirus pandemic
  • If patients have symptoms of an exacerbation or COVID-19 they should be tested for SARS-CoV-2 infection and managed accordingly.

COPD=chronic obstructive pulmonary disease; GOLD=Global Initiative for Chronic Obstructive Lung Disease; TdaP=tetanus, diphtheria, and pertussis; ICS=inhaled corticosteroid; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2

Implementation actions for STPs and ICSs

written by Dr David Jenner, GP, Cullompton, Devon

The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level. Our aim is to help you consider how to deliver improvements to healthcare within the available resources.

  • Share this strategy widely among primary and secondary care teams, including out-of-hours providers
  • Consider publishing a summary sheet of the recommendations for local management of COPD during the COVID-19 pandemic, including diagnosis without access to spirometry
  • Encourage the use of blood eosinophil levels to guide use of inhaled corticosteroids
  • Investigate the feasibility of offering TdaP vaccination to those with no history of childhood vaccination and offering incentives to GP practices to provide this
  • Reassure practices and patients that no change to the use of inhaled and systemic steroids for COPD and its exacerbations is advised during the COVID-19 pandemic.

STP=sustainability and transformation partnership; ICS=integrated care system; COPD=chronic obstructive pulmonary disease; TdaP=tetanus, diptheria, and pertussis

(Video) GOLD in Practice - Supplementary video 1 [ID 222664]

References

  1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. GOLD, 2021. Available at:www.goldcopd.org
  2. Halpin D, Criner G, Papi A et al. Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease—the 2020 GOLD Science Committee report on COVID-19 and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2021; 203 (1): 24–36.
  3. Halpin D, Celli B, Criner G et al. The GOLD summit on chronic obstructive pulmonary disease in low- and middle-income countries. Int J Tuberc Lung Dis 2019; 23 (11): 1131–1141.
  4. Halpin D, Celli B, Criner G et al. It is time for the world to take COPD seriously: a statement from the GOLD board of directors. Eur Respir J 2019; 54 (1): 1900914.
  5. Bafadhel M, Peterson S, De Blas M et al. Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease: a post-hoc analysis of three randomised trials. Lancet Respir Med 2018; 6 (2): 117–126.
  6. Pascoe S, Barnes N, Brusselle G et al. Blood eosinophils and treatment response with triple and dual combination therapy in chronic obstructive pulmonary disease: analysis of the IMPACT trial. Lancet Respir Med 2019; 7 (9): 745–756.
  7. Vestbo J, Papi A, Corradi M et al. Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease (TRINITY): a double-blind, parallel group, randomised controlled trial. Lancet 2017; 389 (10082): 1919–1929.
  8. Lipson D, Barnhart F, Brealey N et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med 2018; 378 (18): 1671–1680.
  9. Papi A, Vestbo J, Fabbri L et al. Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease (TRIBUTE): a double-blind, parallel group, randomised controlled trial. Lancet 2018; 391 (10125): 1076–1084.
  10. Welte T, Miravitlles M, Hernandez P et al. Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2009; 180 (8): 741–750.
  11. Singh D, Brooks J, Hagan G et al. Superiority of “triple” therapy with salmeterol/fluticasone propionate and tiotropium bromide versus individual components in moderate to severe COPD. Thorax 2008; 63 (7): 592–598.
  12. Jung K, Park H, Park S et al. Comparison of tiotropium plus fluticasone propionate/salmeterol with tiotropium in COPD: a randomized controlled study. Respir Med 2012; 106 (3): 382–389.
  13. Hanania N, Crater G, Morris A et al. Benefits of adding fluticasone propionate/salmeterol to tiotropium in moderate to severe COPD. Respir Med 2012; 106 (1): 91–101.
  14. Frith P, Thompson P, Ratnavadivel R et al. Glycopyrronium once-daily significantly improves lung function and health status when combined with salmeterol/fluticasone in patients with COPD: the GLISTEN study, a randomised controlled trial. Thorax 2015; 70 (6): 519–527.
  15. Lipson D, Barnacle H, Birk R et al. FULFIL trial: once-daily triple therapy for patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2017; 196 (4): 438–446.
  16. Siler T, Kerwin E, Singletary K et al. Efficacy and safety of umeclidinium added to fluticasone propionate/salmeterol in patients with COPD: results of two randomized, double-blind studies. COPD 2016; 13 (1): 1–10.
  17. Singh D, Papi A, Corradi M et al. Single inhaler triple therapy versus inhaled corticosteroid plus long-acting beta2-agonist therapy for chronic obstructive pulmonary disease (TRILOGY): a double-blind, parallel group, randomised controlled trial. Lancet 2016; 388 (10048): 963–973.
  18. Rabe K, Martinez F, Ferguson G et al. Triple inhaled therapy at two glucocorticoid doses in moderate-to-very-severe COPD. N Engl J Med 2020; 383 (1): 35–48.
  19. Lipson D, Crim C, Criner G et al. Reduction in all-cause mortality with fluticasone furoate/umeclidinium/vilanterol in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2020; 201 (12): 1508–1516.
  20. Martinez F, Rabe K, Ferguson G et al. Reduced all-cause mortality in the ETHOS trial of budesonide/glycopyrrolate/formoterol for COPD: a randomized, double-blind, multi-center parallel-group study. Am J Respir Crit Care Med 2020; DOI: 10.1164/rccm.202006-2618OC
  21. Perencevich E, Diekema D, Edmond M. Moving personal protective equipment into the community: face shields and containment of COVID-19. JAMA 2020; 323 (22): 2252–2253.
  22. US Centers for Disease Control. Considerations for wearing masks—help slow the spread of COVID-19. www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html (accessed 22 January 2021).
  23. Samannan R, Holt G, Calderon-Candelario R et al. Effect of face masks on gas exchange in healthy persons and patients with COPD. Ann Am Thorac Soc 2020; DOI: 10.1513/AnnalsATS.202007-812RL
  24. Aggarwal A, Gupta D, Jindal S. The relationship between FEV1 and peak expiratory flow in patients with airways obstruction is poor. Chest 2006; 130 (5): 1454–1461.
  25. Pothirat C, Chaiwong W, Phetsuk N et al. Peak expiratory flow rate as a surrogate for forced expiratory volume in 1 second in COPD severity classification in Thailand. Int J Chron Obstruct Pulmon Dis 2015; 10: 1213–1218.
  26. Llewellin P, Sawyer G, Lewis S et al. The relationship between FEV1 and PEF in the assessment of the severity of airways obstruction. Respirology 2002; 7 (4): 333–337.
  27. Jackson H, Hubbard R. Detecting chronic obstructive pulmonary disease using peak flow rate: cross sectional survey. BMJ 2003; 327 (7416): 653–654.
  28. Halpin D, Singh D, Hadfield R. Inhaled corticosteroids and COVID-19: a systematic review and clinical perspective. Eur Resp J 2020; 55 (5): DOI: 10.1183/13993003.01009-2020.
  29. Schultze A, Walker A, MacKenna B et al. Inhaled corticosteroid use and risk COVID-19 related death among 966,461 patients with COPD or asthma: an OpenSAFELY analysis. medRxiv 2020: DOI: 10.1101/2020.06.19.20135491.
  30. Singh D, Halpin D. Inhaled corticosteroids and COVID-19-related mortality: confounding or clarifying? Lancet Respir Med 2020; 8 (11): 1065–1066
  31. Docherty A, Harrison E, Green C et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ 2020; 369: m1985.
  32. Yue H, Zhang M, Xing L et al. The epidemiology and clinical characteristics of co-infection of SARS-CoV-2 and influenza viruses in patients during COVID-19 outbreak. J Med Virol 2020;9 (11): 2870–2873.
  33. Rodriguez-Morales A, Cardona-Ospina J, Gutierrez-Ocampo E et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623.
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FAQs

What is the gold standard for COPD treatment? ›

Non-Pharmacologic Therapy: The GOLD guidelines recommend smoking cessation, flu and pneumococcal vaccinations for patients with COPD in Groups A through D. Vaccinations are one way to reduce exacerbations, which are known to cause a more rapid decline in lung function, increased morbidity and mortality.

What is the newest medicine for COPD? ›

The newly approved Stiolto Respimat combines two drugs to better open airways in patients with chronic obstructive pulmonary disease. The U.S. Food and Drug Administration (FDA) has approved a new medication, Stiolto Respimat, to treat chronic obstructive pulmonary disease (COPD).

Are there any breakthroughs for COPD? ›

Another new breakthrough in COPD treatment is a type of medication called combination inhalers that may be more effective than standard inhalers. Normally, COPD inhalers contain a medication called a bronchodilator that helps open the airways to make breathing easier.

What is the most effective intervention for COPD? ›

For most people with COPD, short-acting bronchodilator inhalers are the first treatment used. Bronchodilators are medicines that make breathing easier by relaxing and widening your airways. There are 2 types of short-acting bronchodilator inhaler: beta-2 agonist inhalers – such as salbutamol and terbutaline.

What are 3 treatments for COPD? ›

You may take some medications on a regular basis and others as needed.
  • Bronchodilators. Bronchodilators are medications that usually come in inhalers — they relax the muscles around your airways. ...
  • Inhaled steroids. ...
  • Combination inhalers. ...
  • Oral steroids. ...
  • Phosphodiesterase-4 inhibitors. ...
  • Theophylline. ...
  • Antibiotics.
15 Apr 2020

What is COPD GOLD Stage 3? ›

The GOLD system involves four stages based on the results of a breathing test called spirometry. Spirometry measures the amount of air your lungs can expel when you breathe out (forced expiratory volume, or FEV).
...
What does stage 3 COPD mean?
GOLD stageCOPD levelFEV score
4very severe< 3% normal
3 more rows
15 Apr 2021

What helps COPD patients breathe? ›

5 Ways to Breathe Easier with COPD
  • Focus on protecting your overall health. Wash your hands. ...
  • Use oxygen therapy if you need it. Supplemental oxygen can help you live longer and with fewer COPD symptoms. ...
  • Follow a healthy COPD diet. ...
  • Take part in a COPD exercise program. ...
  • Be mindful about medications.
7 Jan 2022

How can COPD improve lung function? ›

Exercise, especially aerobic exercise, can:
  1. Improve your circulation and help the body better use oxygen.
  2. Improve your COPD symptoms.
  3. Build energy levels so you can do more activities without becoming tired or short of breath.
  4. Strengthen your heart and cardiovascular system.
  5. Increase endurance.
  6. Lower blood pressure.
14 Sept 2018

Can COPD be stopped from progressing? ›

Is it possible to prevent or slow progression? COPD is a chronic and progressive disease. While it is possible to slow progress and reduce symptoms, it is impossible to cure the disease, and it will gradually worsen over time.

Why do you not give oxygen to COPD patients? ›

Too much oxygen can be dangerous for patients with chronic obstructive pulmonary disease (COPD) with (or at risk of) hypercapnia (partial pressure of carbon dioxide in arterial blood greater than 45 mm Hg). Despite existing guidelines and known risk, patients with hypercapnia are often overoxygenated.

Can lungs heal from COPD? ›

There is no cure for COPD, and the damaged lung tissue doesn't repair itself. However, there are things you can do to slow the progression of the disease, improve your symptoms, stay out of hospital and live longer. Treatment may include: bronchodilator medication – to open the airways.

Is anybody working on a cure for COPD? ›

Currently, there is no way to cure the disease or to completely stop it from getting worse. Scientists are trying to find ways to stop COPD lung damage, and maybe even reverse damage that has already been done. There are already many ways to treat COPD symptoms and to slow the disease's progress.

How much does it cost for stem cell treatment for COPD? ›

Prices are likely to vary among clinics, very few of which, if any, list the treatment costs upfront. A company called DVC Stem offers stem cell therapy in the Cayman Islands and states that the average cost of treatment is between $10,000 and $35,000.

Can stem cells grow new lungs? ›

Researchers have revealed that stem cells transplanted into embryonic mice can mature into fully functional lungs, a method which could be developed to grow lungs for humans. Using transplanted stem cells, researchers have grown a pair of fully functional lungs in mouse embryos.

How do you increase oxygen levels in COPD? ›

Oxygen treatment for COPD

People who experience hypoxemia may require oxygen therapy to increase their blood oxygen levels. This therapy involves using an oxygen tank to deliver additional oxygen through a face mask or a tube in the nose or mouth.

What medications should be avoided with COPD? ›

Experts say people generally shouldn't use Percodan if they have respiratory trouble, such as COPD or asthma, because opioid medications like oxycodone can make breathing shallow or slow. This can be dangerous, and the danger can be magnified for people who already have breathing problems.

Is there a shot for COPD? ›

Pneumococcal Vaccine.

The two pneumococcal vaccines, PCV13 and PPSV23, are recommended for all adults 65 years or older, particularly those with chronic lung conditions like COPD. They are also specifically recommended for younger individuals with COPD.

What is life expectancy with Stage 3 COPD? ›

Stage 3: 5.8 years.

Can Stage 3 COPD be reversed? ›

You can't reverse your emphysema or COPD. But you can ease your symptoms and slow the progress of the disease. And the earlier you act, the better. Quit smoking.

What stage of COPD do you start losing weight? ›

Weight loss can become an issue during stage III. That's because when you're tired and short of breath, you may lose your desire to eat. That can set up a tough cycle. When you don't get the nutrients you need, your symptoms can get worse.

What can worsen COPD? ›

These are some of the things that can make your COPD worse and spark a flare-up:
  • Smog and other kinds of air pollution.
  • Cigarette or cigar smoke.
  • Strong fumes from perfume and other scented products.
  • Cold air or hot, humid air.
  • Ragweed and other pollens that trigger allergies.
18 Mar 2021

What is the safest inhaler for COPD? ›

Advair. Advair is one of the most commonly used inhalers for the maintenance treatment of COPD. It is a combination of fluticasone, a corticosteroid, and salmeterol, a long-acting bronchodilator. Advair is used on a regular basis for the maintenance treatment of COPD and it is typically taken twice per day.

What is the best bronchodilator for COPD? ›

Fast-Acting Bronchodilators for COPD
  • Albuterol (Ventolin®, Proventil®, AccuNeb®)
  • Albuterol sulfate (ProAir® HFA®, ProAir RespiClick)
  • Levalbuterol (Xopenex®)
14 Sept 2018

What is a normal oxygen level for someone with COPD? ›

Official answer. Between 88% and 92% oxygen level is considered safe for someone with moderate to severe COPD. Oxygen levels below 88% become dangerous, and you should ring your doctor if it drops below that. If oxygen levels dip to 84% or below, go to the hospital.

What is the best exercise for lungs? ›

Aerobic activities like walking, running or jumping rope give your heart and lungs the kind of workout they need to function efficiently. Muscle-strengthening activities like weight-lifting or Pilates build core strength, improving your posture, and toning your breathing muscles.

How can I make my lungs stronger? ›

Follow these nine tips and to help improve your lung health and keep these vital organs going strong for life:
  1. Diaphragmatic breathing. ...
  2. Simple deep breathing. ...
  3. 'Counting' your breaths. ...
  4. Watching your posture. ...
  5. Staying hydrated. ...
  6. Laughing. ...
  7. Staying active. ...
  8. Joining a breathing club.

How far should I walk with COPD? ›

The researchers say that walking between three and six kilometers (or 1.8 to 3.7 miles) per day helps. “COPD patients are less likely to engage in regular physical activity than healthy individuals,” lead researcher Dr. Cristóbal Esteban said.

Does drinking a lot of water help COPD? ›

Water is very important for your body to be able to function properly. For example, water helps regulate your temperature, gets rid of wastes and lubricates your joints. It is very important for people with COPD because it helps to thin mucus making it easier to cough up.

Is Climbing stairs good for COPD? ›

In conclusion, walking and stair-climbing lead to a comparable decline in PaO2 in patients with severe COPD. However, stair-climbing resulted in more pronounced hyperinflation of the lungs, higher blood lactate levels and more dyspnea compared to walking.

What is the first line treatment for COPD exacerbation? ›

BRONCHODILATORS. Inhaled beta2 agonists should be administered as soon as possible during an acute exacerbation of COPD. Use of a nebulizer to provide albuterol (Ventolin) or a similar agent with saline and oxygen enhances delivery of the medication to the airways.

What is the GOLD ABCD classification for COPD? ›

Each of these studies addresses the distribution of COPD patients by the new classification and assigns them to the each of the four proposed quadrants: A: few symptoms, better lung function; B: more symptoms, better lung function; C: few symptoms, poor lung function; D: more symptoms, poor lung function.

What are the GOLD criteria? ›

The GOLD Criteria are used clinically to determine the severity of expiratory airflow obstruction for patients with COPD. Should not be used to diagnose COPD, but rather to categorize clinical severity to inform prognosis and to guide therapeutic interventions.

What is the latest treatment for COPD UK? ›

Roflumilast is recommended as an option to treat adults with severe COPD whose symptoms continue to worsen despite other treatments. It is a once-a-day tablet that works to reduce irritation and swelling in airways of people with COPD. Around 122,000 adults in England will be eligible to receive roflumilast.

Why do you not give oxygen to COPD patients? ›

Too much oxygen can be dangerous for patients with chronic obstructive pulmonary disease (COPD) with (or at risk of) hypercapnia (partial pressure of carbon dioxide in arterial blood greater than 45 mm Hg). Despite existing guidelines and known risk, patients with hypercapnia are often overoxygenated.

What triggers COPD flare-ups? ›

The two most common causes of a COPD flare-up, or attack, are respiratory tract infections, such as acute bronchitis or pneumonia, and air pollution. Having other health problems, such as heart failure or an abnormal heartbeat (arrhythmia) may also trigger a flare-up.

What is the best medication for COPD flare-ups? ›

Albuterol (branded options include ProAir® HFA, Proventil® HFA, Ventolin® HFA) is commonly used to treat COPD exacerbations. This medication is typically taken through an inhaler, but can also be taken as a liquid solution for nebulizer use.

What is COPD GOLD Stage 4? ›

Stage 4 -- Very Severe -- FEV-1 ≤30%: You might have lung or heart failure. This can make it hard to catch your breath even when you're resting. You might hear this called end-stage COPD.

What is GOLD ABCD assessment tool? ›

Their 'ABCD' Assessment Tool combines the use of FEV1 GOLD [1–4] for staging airway obstruction and severity measures that include the number of exacerbations/hospitalizations and patient's functional status (Table 1) and recommends treatment options for each category.

What is Stage 2 moderate COPD by GOLD classification? ›

According to the GOLD guidelines, a person has stage 2 COPD if their FEV1 value is between 50 and 79%. FEV1 indicates the amount of air a person can forcefully exhale in 1 second as measured by a spirometry machine. It is of note, however, that the FEV1 measurement captures only one component of the COPD severity.

What would the predicted FEV1 be for GOLD 4 very severe COPD? ›

The 'GOLD-COPD' was graded using post-bronchodilator % of predicted FEV1 values: GOLD stage 1 (mild): ≥ 80%; stage 2 (moderate): 50-79%; stage 3 (severe): 30-49; stage 4 (very severe) < 30% [4].

What is the FEV1 for severe COPD? ›

Stage IV: Very Severe COPD Severe airflow limitation (FEV1/FVC < 70%; FEV1 < 30% predicted) or FEV1 < 50% predicted plus chronic respiratory failure. Patients may have Very Severe (Stage IV) COPD even if the FEV1 is > 30% predicted, whenever this complication is present.

Does moderate COPD qualify for disability? ›

If your COPD causes you to be out of work for at least 12 months, then yes, you could qualify for Social Security Disability Insurance (SSDI). When you apply for SSDI with COPD, in order to be approved, you need to meet a certain medical criteria outlined by the SSA.

Can COPD go into remission? ›

Chronic obstructive pulmonary disease makes it increasingly difficult for a person to breathe. It is not currently possible to cure or reverse the condition completely, but a person can reduce its impact by making some treatment and lifestyle changes.

How can I improve my lung function with COPD? ›

5 Ways to Breathe Easier with COPD
  1. Focus on protecting your overall health. Wash your hands. ...
  2. Use oxygen therapy if you need it. Supplemental oxygen can help you live longer and with fewer COPD symptoms. ...
  3. Follow a healthy COPD diet. ...
  4. Take part in a COPD exercise program. ...
  5. Be mindful about medications.
7 Jan 2022

What stops COPD cough? ›

Short- or long-acting inhaled beta-agonists such as albuterol or salmeterol (Serevent Diskus) will sometimes help decrease coughing. Beta-agonists are a type of bronchodilator that helps open your airways and get more oxygen into your lungs.

Videos

1. COPD Management 2022
(Moses Cone Pharmacy Residents)
2. The New GOLD Classification of COPD -- BAVLS
(American Thoracic Society)
3. COPD GOLD criteria | How to remember |
(Crazy Medicine)
4. COPD: A review of what's new in the updated GOLD guidelines
(UHSP Alumni)
5. GOLD in Practice - Supplementary video 2 [ID 222664]
(Dove Medical Press)
6. COPD Updates | GOLD 2022 | Part 1
(Respiratory & Critical Care - Mansoura University)

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