March 06, 2018
Recent updates to treatment recommendations for patients with stable chronic obstructive pulmonary disease (COPD) emphasize comprehensive symptom assessment for both initiating therapy and appropriately escalating treatment, according to an article in a sponsored supplement in The Journal of Family Practice.
The Global Initiative for Obstructive Lung Disease (GOLD) guidelines use respiratory symptoms and exacerbations to assign patients to 1 of 4 categories: GOLD A patients have low symptoms and low exacerbation frequency; GOLD B patients, high symptoms and low frequency of exacerbations; GOLD C patients, low symptoms and high exacerbation frequency; and GOLD D patients, high symptoms and high exacerbation frequency.
Central to COPD management are smoking cessation and pulmonary rehabilitation, which are appropriate for all stages of COPD, according to authors Barbara Yawn, MD, MSc, FAAFP, of the department of family and community health at the University of Minnesota, and Victor Kim, MD, of the department of thoracic medicine and surgery at the Temple University School of Medicine. Long-term oxygen therapy is another nonpharmacologic treatment option for select patients.
Pharmacologic treatment options differ with GOLD grades and include bronchodilators, long-acting muscarinic receptor antagonists, long-acting β2-agonists, and inhaled corticosteroids, according to the article.
First- and second-line treatment options under COPD Foundation guidelines, meanwhile, are similar to GOLD recommendations and based on diagnosis and severity assessment. Both the GOLD and COPD Foundation guidelines promote individualized care and partnerships between patients and providers.
“Defining personal treatment goals for patients with COPD can enhance patient and physician communication and encourage continued collaboration to improve adherence and outcomes,” the authors wrote. “Regularly monitoring symptoms, exacerbations, and comorbidities via patient-focused questionnaires, and closely examining patient adherence and technique, form a fundamental part of care for patients with COPD.”
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