Once a year we review and update the clinical practice guidelines as needed for some chronic conditions. We have updated our guidelines for chronic obstructive pulmonary disease (COPD) based on the information from the Global Initiative for Chronic Obstructive Lung Disease 2019 report.*
Highlights of the changes are:
- Algorithms for the initiation and follow-up management of pharmacological treatment have been revised. New diagrams have been developed to improve clarity and incorporate recent advances in knowledge.
- A model for the initiation of pharmacological management of COPD according to the individualized assessments of symptoms and exacerbation risk, following the ABCD assessment scheme, was developed.
- Following implementation of therapy, patients should be reassessed for attainment of their treatment goals and identification of any barriers for successful treatment.
- Following review of the patient response to treatment initiation, adjustments in pharmacological treatment may be needed.
- A separate algorithm is provided for follow-up treatment where management is still based on symptoms and exacerbations but the recommendation does not depend on the patient’s GOLD (Global Initiative for Chronic Obstructive Lung Disease) group at diagnosis.
- These follow-up recommendations are designed to facilitate management of patients taking maintenance treatment(s), whether early after initial treatment or after years of follow-up.
- These recommendations incorporate recent evidence from clinical trials and the use of peripheral blood eosinophil counts as a biomarker to guide the use of inhaled corticosteroid (ICS) therapy for exacerbation prevention.
- The response to treatment escalation should always be reviewed and de-escalation should be considered if there is a lack of clinical benefit and/or side effects occur.
- De-escalation may also be considered in COPD patients receiving treatment who return with a resolution of symptoms that subsequently require less therapy.
*Source: Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2019 Report. https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf (last accessed 11 March 2019).