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For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact userservices@mhprofessional.com.
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Content Update
May 06, 2024
GOLD Guidelines Treatment Updates: The 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines updated initial treatment groups for COPD from four to three (ie, groups A, B, and E). Patients with any level of symptoms but an elevated exacerbation risk were combined into a new group E classification, highlighting the importance of COPD exacerbations. Group E COPD patients should now be started on either long-acting beta-agonist (LABA) + long-acting muscarinic-antagonist (LAMA) dual therapy or triple therapy with LABA + LAMA + inhaled corticosteroid (ICS). Triple therapy appears to reduce moderate-severe COPD exacerbations and mortality when compared to dual therapy (particularly in patients with elevated serum eosinophil levels) and has taken a significantly more prominent role in COPD treatment recommendations due to these documented benefits.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
Describe the pathophysiology of chronic obstructive pulmonary disease (COPD).
Assess a patient for signs and symptoms of COPD.
List the treatment goals for a patient with COPD.
Design an appropriate COPD maintenance treatment regimen based on patient-specific data.
Design an appropriate COPD exacerbation treatment regimen based on patient-specific data.
Develop a monitoring plan to assess effectiveness and adverse effects of pharmacotherapy for COPD.
Formulate an appropriate education plan for a patient with COPD.
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Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation that is not fully reversible. Previous definitions of COPD included chronic bronchitis and emphysema. Chronic bronchitis is defined clinically as a chronic productive cough for at least 3 months in each of 2 consecutive years in a patient in whom other causes have been excluded.1 Emphysema is defined pathologically as destruction of alveoli.1 The major risk factor for both conditions is cigarette smoking, and many patients share characteristics of each one. Therefore, current guidelines focus instead on chronic airflow limitation.
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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is an expert panel of health professionals who developed consensus guidelines for the diagnosis and care of patients with COPD that are updated annually.1
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EPIDEMIOLOGY AND ETIOLOGY
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COPD is a major cause of morbidity and mortality and a significant cause of disability worldwide. In 2017, the estimated prevalence of COPD in the United States was 6.4%.2 Over 169,000 adults died from COPD, making it the fourth leading cause of death.2,3 Personal health care spending in the United States on COPD was estimated to be $53.8 billion in 2013.4 In addition, patients with COPD have a higher prevalence of coronary artery disease and hypertension.5 Other common comorbidities that can impact disease course and prognosis include lung cancer, heart failure, gastroesophageal reflux disease ...