The official blog of the Lung Institute.
The new COPD Treatment Guidelines are out. Here’s how to make sense of them.
When it comes to living with chronic obstructive pulmonary disease (COPD), it’s important to understand your disease, how it developed as well as your current stage or status to determine what a healthy treatment regimen should look like. Although we’ve spoken on COPD stages and what to do about them before, if you suffer from COPD, understanding the GOLD COPD treatment guidelines is vital.
So, what are they?
In short, the COPD treatment guidelines are, as their name suggests, a comprehensive document for doctors and patients to guide them in determining an appropriate treatment plan. These types of guidelines are vital for a patient particularly as they can give you a broader idea of your current state of health and the best options available for you.
With your health in mind, the Lung Institute is here to outline and break down the GOLD’s COPD Treatment Guidelines: What Do They Mean for Me?
What Are the COPD Treatment Guidelines?
To give a brief overview of what the COPD treatment guidelines are, it’s important to understand just what the GOLD is. The Global Initiative for Obstructive Lung Disease (GOLD) is an international collaboration of doctors and COPD experts that convene every few years or so to discuss the state of current medicine for the treatment of the disease. In these meetings, they will go over current pharmaceuticals, non-pharmacologic treatment options (lung transplants or supplemental oxygen for example) and which among the methods available are the best for treating COPD.
So, on the topic of occasional updates, the GOLD recently put out a 2017 edition to their COPD treatment guidelines. Here’s what you need to know:
Recent Updates and Facts to Know
As the GOLD meets every few years or so, there are often important advancements underway within the field of COPD treatment that cause certain aspects of the guidelines to be revised. Given that the GOLD members are comprised of doctors and other COPD experts, the way in which these revisions and updates are written tend to be in the form of prescribed advice to both doctors and patients.
Among the most notable updates are:
ABCD Rating System
A refinement of the guideline’s ABCD rating system. This rating system is, as it sounds, a ranking using letters of a patient’s COPD severity with A being the highest (best health) and D being the lowest (worst health). In the past, this system covered spirometry, but this metric has since been removed to focus on other quality of life concerns such as symptom expression and risk of exacerbations to determine the appropriate pharmacologic treatment suggestion. In this recent revision, although the authors push forth the assertion that spirometry is important to disease diagnosis and prognosis, this information is irrelevant to the prescribing of traditional inhaler-based medication.
The ABCD COPD GOLD rating system appears as follows:
- A Grade COPD GOLD: Any bronchodilator (short or long acting), titrating or switching to another as appropriate.
- B Grade COPD GOLD: A long acting bronchodilator (LAMA* or LABA*), and both types if symptoms persist with one drug.
- C Grade COPD GOLD: A long acting muscarinic antagonist (LAMA), switching to LAMA + LABA or to LABA + ICS* if further exacerbations occur.
- D Grade COPD GOLD: More complicated, requires individual management, often drugs, consideration of roflumilast and azithromycin in select patients.
*LAMA= Long-Acting Muscarinic Antagonist
*LABA= Long-Acting Beta-Agonist
*ICS= Inhaled Corticosteroid
Recommended Treatment Options
Among the recommended treatment options set forth by the GOLD, long-acting bronchodilators, inhaled corticosteroids and oral phosphodiesterase type 4 inhibitor were suggested. Although we’ve discussed the side effects and issues that are inherent with long-term inhaler use, the use of a combination inhaler such as a long-acting beta-agonist, or a long-acting muscarinic antagonist can be helpful in slowing the progression of COPD development and reducing your symptom expression.
Currently, within the state of COPD treatment, supplemental oxygen has often been prescribed to patients with stable COPD. However, the problem with this over-prescription, for those who had a stable condition, was that statistically the supplemental oxygen wasn’t improving their condition or quality of life. In this discovery, the GOLD committee has now revised their literature to recommend that supplemental oxygen only be prescribed for those with severe resting hypoxemia (low blood oxygen).
Non-Pharmaceutical Treatment Options
Aside from traditional treatment options such as inhalers and medication, the GOLD committee also went forth to revise their suggestions for non-pharmaceutical treatment options, including:
- Pulmonary rehabilitation (recommended for patients with severe symptoms or frequent exacerbations)
- Exercise (for all patients)
- Vaccination against the flu (all patients) and pneumococcus (all COPD patients older than 65 or with cardiopulmonary disease)
- Daily oral opioids for severe COPD symptoms refractory to medical therapy
- Palliative care
What Does This Mean for Me?
Although the GOLD committee has historically focused on pharmaceutical-based treatment options, there are a variety of traditional and emerging treatment options available to the average patient. In this sense, it is an exciting time for the medical field and their ability to treat COPD using a variety of continually tested and applied methods. In the case for cellular therapy, the field has grown exponentially in recent years as an emerging treatment option, often allowing a more significant reduction of symptom expression and has the potential to reduce disease progression in comparison to—at times—ineffective medications and inhalers.
The GOLD COPD treatment guidelines should be understood and realized to affect the best treatment plan. However, non-pharmaceutical-based treatment options such as natural supplements, exercise and a healthy COPD diet should not be neglected.
So, What’s Next?
COPD Treatment guidelines can be critical in planning and executing an appropriate treatment regimen. However, to address the progressive symptoms of lung disease at the source, the first step in this process is to quit smoking. The second is to address your lifestyle through simple diet and exercise changes. With these behavioral changes, it’s possible to greatly affect the pronouncement of symptoms within those with COPD, pulmonary fibrosis and emphysema. However, when lifestyle changes fail to improve your quality of life in the way that you may expect, it may be time to consider cellular therapy. Rather than addressing the symptoms of lung disease, cellular therapy may directly affect disease progression and may improve quality of life.
If you or a loved one suffers from a chronic lung disease like COPD, PF or ILD, the Lung Institute may be able to help with a variety of adult cellular therapy options. Contact us today at (800) 729-3065 to see if you qualify for cellular therapy, and find out what cellular therapy could mean for you.
Interested in our article on COPD Treatment Guidelines: What Do They Mean for Me? Share your thoughts and comments below.