“As with many other chronic diseases, laboratory measures don’t always consistently reflect the extent of a person’s clinical symptoms or quality of life.”

Updated recommendations for managing COPD.

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It’s nearly autumn, the time of year when we start to see exacerbations of chronic lung disease, including COPD. That’s why we’ve included an informative and readable COPD update in this month’s AJN.

Authors Amy O’Dell and colleagues discuss the latest recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD). GOLD was launched 20 years ago in order to disseminate strategies for the prevention and management of this disease. The most recent GOLD report was released in 2017, with its recommendations further tweaked this year.

Treatment category based on spirometry plus symptoms and history.

One of the most exciting aspects of the 2017 recommendations is the way in which spirometry and a person’s clinical symptoms and history of exacerbations have been put together in order to determine a patient’s treatment category.

In the past, spirometric measurements have been key drivers of treatment. Yet as with many other chronic diseases, laboratory measures don’t always consistently reflect the extent of a person’s clinical symptoms or quality of life. Some people have “off the charts” lab readings for some condition, yet they experience minimal symptoms. For others, lab results can be close to normal even when that person is experiencing life-limiting symptoms. The GOLD recommendations carefully “cross-match” the objective measure (spirometry) with a person’s symptoms and exacerbation history in order to determine an optimal level of treatment. 

Drug treatment algorithms for the four treatment categories.

While the GOLD report does include nonpharmacologic recommendations for COPD prevention and control, its drug treatment algorithms for the four treatment categories are particularly clear and useful. The algorithms include specific recommendations for escalating and deescalating drug treatment within each category.

Learn more in “Managing Stable COPD:  An Evidence-Based Approach” in this month’s AJN. CE credit is available with this article.