Global Initiative for Chronic Disease

Global Initiative for Chronic Obstructive Lung Disease

DISTRIBUTE OR COPY NOT ATERIAL-DO M COPYRIGHTED

POCKET GUIDE TO

COPD DIAGNOSIS, MANAGEMENT,

AND PREVENTION

A Guide for Health Care Professionals

2019 REPORT

GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE

POCKET GUIDE TO COPD DIAGNOSIS, MANAGEMENT, AND PREVENTION A Guide for Health Care Professionals 2019 EDITION

DISTRIBUTE R O COPY NOT ATERIAL-DO M COPYRIGHTED

? 2019 Global Initiative for Chronic Obstructive Lung Disease, Inc.

ii

GOLD BOARD OF DIRECTORS (2018)

GOLD SCIENCE COMMITTEE* (2018)

Alvar Agusti, MD, Chair

Claus Vogelmeier, MD, Chair

Alberto Papi, MD

Respiratory Institute,

University of Marburg

University of Ferrara

Hospital Clinic, IDIBAPS

Marburg, Germany

Ferrara, Italy

Univ. Barcelona and Ciberes

Barcelona, Spain

Alvar Agusti, MD

Ian Pavord, MA DM

Respiratory Institute, Hospital

University of Oxford

Bartolome R. Celli, MD

Clinic, IDIBAPS

Oxford, UK

Brigham and Women's Hospital

Univ. Barcelona and Ciberes

Boston, Massachusetts, USA

Barcelona, Spain

Nicolas Roche, MD

University Paris Descartes

Rongchang Chen, MD

Antonio Anzueto, MD

H?pital Cochin APHP

Guangzhou Institute of Respiratory

University of Texas

Paris, France

Disease

Health Science Center

Guangzhou, PRC

San Antonio, Texas, USA

Donald Sin, MD

St. Paul's Hospital, University of

Gerard Criner, MD Temple University School of Medicine Philadelphia, Pennsylvania, USA

Peter Frith, MD Flinders Hospital, Adelaide, Australia

Peter Barnes, MD

TE National Heart and Lung Institute U London, United Kingdom TRIB Jean Bourbeau, MD IS McGill University Health Centre OR D Montreal, Canada

British Columbia Vancouver, Canada

Dave Singh, MD University of Manchester Manchester, UK

Robert Stockley, MD

David Halpin, MD Royal Devon and Exeter Hospital Devon, UK

Gerard Criner, MD

PY Temple University School of Medicine CO Philadelphia, Pennsylvania, USA

T

University Hospital Birmingham, UK

J?rgen Vestbo, MD

M. Victorina L?pez Varela, MD Universidad de la Rep?blica

O Peter Frith, MD N Repatriation General Hospital

University of Manchester Manchester, England, UK

Montevideo, Uruguay

Masaharu Nishimura, MD (retired May, 2018) Hokkaido University School of Medicine Sapporo, Japan

O Adelaide, Australia AL-D David Halpin, MD RI Royal Devon and Exeter Hospital ATE Devon, United Kingdom

Jadwiga A. Wedzicha, MD Imperial College London London, UK

M. Victorina L?pez Varela,MD

M MeiLan Han, MD MS

Universidad de la Rep?blica

D Sundeep Salvi, MD TE Chest Research Foundation H Pune, India YRIG Claus Vogelmeier, MD P University of Marburg CO Marburg, Germany

University of Michigan Ann Arbor, MI, USA

Fernando J. Martinez, MD MS New York-Presbyterian Hospital/ Weill Cornell Medical Center New York, NY, USA

Hospital Maciel Montevideo, Uruguay

GOLD PROGRAM DIRECTOR Rebecca Decker, MSJ Fontana, Wisconsin, USA

EDITORIAL ASSISTANCE Ruth Hadfield, PhD, Sydney, Australia Michael Hess, RRT RPFT, Michigan, USA

*Disclosure forms for GOLD Committees are posted on the GOLD Website,

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TABLE OF CONTENTS

TABLE OF CONTENTS..................................................IV

OTHER TREATMENTS ............................................... 26

GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF COPD............... 5

Oxygen therapy and ventilatory support ............ 26 Ventilatory Support ............................................ 26 Surgical Interventions ......................................... 27

INTRODUCTION ......................................................... 5

MANAGEMENT OF STABLE COPD ...............................28

DEFINITION AND OVERVIEW ....................................... 5

OVERALL KEY POINTS:.........................................28

OVERALL KEY POINTS: .......................................... 5

IDENTIFY AND REDUCE EXPOSURE TO RISK FACTORS

WHAT IS CHRONIC OBSTRUCTIVE PULMONARY

................................................................................. 28

DISEASE (COPD)? ....................................................... 6

TREATMENT OF STABLE COPD: PHARMACOLOGICAL

WHAT CAUSES COPD?................................................ 6

TREATMENT ............................................................. 29

DIAGNOSIS AND ASSESSMENT OF COPD...................... 8

Algorithms for the assessment, initiation and follow-up management of pharmacological

OVERALL KEY POINTS: .......................................... 8 DIAGNOSIS................................................................. 8 DIFFERENTIAL DIAGNOSIS.......................................... 8 ASSESSMENT ............................................................. 9

Classification of severity of airflow limitation ...... 9 Assessment of symptoms ................................... 12 Combined COPD assessment .............................. 12

treatment ........................................................... 31

TE TREATMENT OF STABLE COPD: NONIBU PHARMACOLOGICAL TREATMENT ........................... 37

TR Education and self-management........................37 DIS Oxygen therapy .................................................. 38 R MONITORING AND FOLLOW-UP ..............................40

O

EVIDENCE SUPPORTING PREVENTION AND MAINTENANCE THERAPY........................................... 13

PY MANAGEMENT OF EXACERBATIONS ..........................40 COOVERALL KEY POINTS:.........................................40

TTREATMENT OPTIONS..............................................41

O OVERALL KEY POINTS: ........................................ 13 N SMOKING CESSATION .............................................. 14 DO VACCINATIONS ........................................................ 14 L- PHARMACOLOGICAL THERAPY FOR STABLE COPD... 15

RIA Overview of the medications .............................. 15 TE Bronchodilators .................................................. 15 MA Antimuscarinic drugs.......................................... 16

Treatment setting ............................................... 41 Respiratory support ............................................ 43 Hospital discharge and follow-up ....................... 45 Prevention of exacerbations ............................... 47

COPD AND COMORBIDITIES .......................................48

OVERALL KEY POINTS: ......................................... 48

D Methylxanthines................................................. 18 E Combination bronchodilator therapy ................. 18 HT Anti-inflammatory agents .................................. 19 IG Inhaled corticosteroids (ICS) ............................... 19 PYR Triple inhaled therapy ........................................ 23 CO Oral glucocorticoids............................................ 23

REFERENCES............................................................. 48

Phosphodiesterase-4 (PDE4) inhibitors .............. 23

Antibiotics........................................................... 23

Mucolytic (mucokinetics, mucoregulators) and

antioxidant agents (NAC, carbocysteine) ........... 24

Issues related to inhaled delivery ....................... 24

Other pharmacological treatments .................... 24

REHABILITATION, EDUCATION & SELF-MANAGEMENT

................................................................................. 25

Pulmonary rehabilitation.................................... 25

SUPPORTIVE, PALLIATIVE, END-OF-LIFE & HOSPICE

CARE ........................................................................ 25

Symptom control and palliative care.................. 25

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GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF COPD

INTRODUCTION

Chronic Obstructive Pulmonary Disease (COPD) is currently the fourth leading cause of death in the

world1 but is projected to be the 3rd leading cause of death by 2020. More than 3 million people died

of COPD in 2012 accounting for 6% of all deaths globally. COPD represents an important public

health challenge that is both preventable and treatable. COPD is a major cause of chronic morbidity

and mortality throughout the world; many people suffer from this disease for years, and die

prematurely from it or its complications. Globally, the COPD burden is projected to increase in coming

decades because of continued exposure to COPD risk factors and aging of the population.2

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DEFINITION AND OVERVIEW NOT

OVE?tls?iRrimgeCTAnahihtiLterafaoLitcmbniaKolioencnEstdOYtteihbcsxPaeospttaOmorisussImePNucdttoYruTihenvReSaetIrt:otGePoisHsnupaolTcmiihxrrEawiaoDotrnauoaMaysrcyrAtpayesTnarDyEdrimzti/RsieocepIdlArateobLassem-yloDv(prseOCeogiOnrlaascPsirlDseutasd)eb.einsntdoaryrecsmsoppamnilerimtaaite,ooscnrou,yupssguryehamvlalepynntcdotaa/muobssrleeasdpanunbdtdyauimrflow production. ThCeOse symptoms may be under-reported by patients.

? The main risk factor for COPD is tobacco smoking but other environmental exposures such as biomass fuel exposure and air pollution may contribute. Besides exposures, host factors predispose individuals to develop COPD. These include genetic abnormalities, abnormal lung development and accelerated aging.

? COPD may be punctuated by periods of acute worsening of respiratory symptoms, called exacerbations.

? In most patients, COPD is associated with significant concomitant chronic diseases, which increase its morbidity and mortality.

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