Winter 2015/2016
In January 2015, an updated version of The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Guidelines was published. Some highlights include:
1. Consider Chronic Obstructive Pulmonary Disease (COPD) in those with dyspnea, chronic cough or sputum production and a history of exposure to risk factors for the disease (tobacco smoke, smoke from cooking and heating fuels, occupational dusts and chemicals).
2. In order to make a confident clinical diagnosis, spirometry is now required.
- A post-bronchodilator FEV1/FVC <0.70 defines airway limitation.
3. A new chapter titled Therapeutic Options has been added.
- The necessity of smoking cessation is stressed, particularly the use of pharmacologic agents with a supportive intervention program to achieve permanent abstinence.
- It is important to assess inhaler technique, particularly with many different types of inhaler devices now available (i.e. metered dose, dry powder and soft mist).
- Bronchodilators, in the form of a beta2-agonist or an anticholinergic, remain a mainstay for the treatment of COPD.
- Long-acting agents are more effective for maintaining symptomatic relief as compared to short-acting agents.
- The role of inhaled corticosteroids in stable COPD is limited, however, when combined with a long acting beta2-agonist, these have been shown to be more effective in improving lung function, reducing exacerbations and health status in those with moderate to very severe COPD.
4. Non-pharmacological options are also reviewed in this literature, including the benefits and components of a pulmonary rehabilitation program.
For additional information, the full report is available at www.goldcopd.com.