COPD insider

The GOLD Standards
2017 update:
what you need to know

 

Discover key updates to the 2017 GOLD Report and how these new revisions may impact your care practice.

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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released their latest report with recommendations for the assessment and treatment of chronic obstructive pulmonary disease (COPD). Below, we review key changes and their potential impact on your practice.
COPD is a treatable condition. It may not be curable yet, but there is always something that can be done to improve a patient’s quality of life.”

Gerard Criner, MD, FACP, FACCP

Division of Pulmonary and Critical Care Medicine Temple University School of Medicine

Chapter 1: redefining COPD

 

The definition of COPD has been broadened to include the impact of chronic respiratory symptoms and the role airway abnormalities play in the development of COPD. The causes of COPD are analyzed relative to medical history and environmental exposures.

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Previous definition of COPD

 

Chronic obstructive pulmonary disease (COPD), a common, preventable, and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases.

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Updated definition of COPD

 

Chronic obstructive pulmonary disease (COPD), a common, preventable, and treatable disease, is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.

Chapter 1 Key takeaway

Key takeaway

 

Broader inclusion criteria means that there may be a larger patient population affected by COPD. It is critical to recognize that chronic respiratory symptoms may precede airflow limitations and that symptoms may also exist in patients with normal spirometry.

Chapter 2: a refined ABCD assessment

 

The ABCD assessment tool has been updated to separate airflow limitations from clinical parameters. With this change, the process of categorizing patients no longer relies solely on spirometry. While spirometry is required to make a COPD diagnosis, the condition should be considered in any patient who has dyspnea, chronic cough, sputum production, or a history of exposure to risk factors. ABCD categories should now be assigned based on respiratory symptoms and each patient’s individual history of exacerbations.

The refined ABCD assessment tool

Chapter 2 chart

Consider this patient

  • FEV1 = 43
  • 1 exacerbation without hospitalization
  • mMRC 1, CAT 8
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Previous classification

GOLD grade 3, group C.
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2017 GOLD Standards classification

Group A
Adapted from: Global Initiative for Chronic Obstructive Lung Disease; 2017.
Chapter 2 Key takeaway

Key takeaway

 

The refined ABCD assessment tool now clearly shows what is being evaluated. Once a diagnosis is made, the updated tool allows for better stratification of patients and opens the door to a more individualized treatment approach.

Chapter 3: support for nonpharmacological therapies

 

Evidence continues to build for nonpharmacological therapies in the treatment of COPD. These treatments, combined with advanced patient stratification methods, are making it possible for physicians to provide a more robust treatment approach.

Nonpharmacological treatment options

 

Pulmonary rehab: Activities including muscle strengthening and endurance training improve dyspnea, quality of life, and exercise tolerance in stable patients.


Self-management: Technical information about disease, medication, and device usage has proven to be insufficient in empowering patients to manage their own disease. Beyond this education, self-management intervention and ongoing engagement with healthcare teams has shown to improve long-term health and decrease hospitalizations.

Integrated care: Successful treatment of COPD requires the input of multiple care providers. Integrated care should be delivered and individualized to each patient and their stage of illness.

 

Palliative care: Care teams should focus on relieving patient suffering and improving their overall quality of life. This includes working with and educating family members or caretakers and helping to facilitate discussions around end-of-life care.


Noninvasive ventilation (NIV): In the event of an exacerbation, NIV has been shown to improve acute respiratory acidosis, lower respiratory rates, and help with breathlessness. In addition, intubation rates and mortality have shown to decrease with NIV.

Chapter 3 Key takeaway

Key takeaway

 

Nonpharmacological treatment options not only complement drug therapy but also help empower patients to take ownership of their own care. These interventions should be considered relative to treatment and end-of-life goals.

Chapter 4: personalized COPD care

 

GOLD introduces a shift toward better patient segmentation and more personalized approaches to treatment. Care teams should consider individual disease presentation and future risk of exacerbations.

Key takeaway

 

The 2 main clinical goals for treating patients with COPD are to:

Chapter 4 Key takeaway

Reduce symptoms by:

  • Relieving symptoms
  • Improving exercise tolerance
  • Improving health status

Reduce risk by: 

  • Preventing disease progression
  • Preventing and treating exacerbations
  • Reducing mortality
The benefits and risks of various treatment plans should be tailored to individual patient characteristics including symptom severity, risk of exacerbations, side effects, comorbidities, and specific underlying mechanisms.

Raising the standards


As we uncover better protocols for diagnosis and treatment, we open new possibilities for better outcomes. These new GOLD Standards are now in your hands, in your ongoing efforts to improve your patients’ lives and your institution’s performance.


As always, COPD Insider is your committed partner at every breath.

 

Source: Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2017 Report. http://goldcopd.org. Accessed December 9, 2016.

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