GOLD releases 2019 update on COPD

  • The Global Initiative for Chronic Obstructive Lung Disease

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Insights from the newest COPD literature include using health records for case detection, role of pneumococcal vaccination, updates on initiation, and eosinophil-guided follow-up of pharmacologic treatment. 

Why this matters

  • By 2020, COPD is expected to become the world’s third leading cause of death.

Description

  • Global Initiative for Chronic Obstructive Lung Disease (GOLD)’s updated consensus report on Global Strategy for the Diagnosis, Management, and Prevention of COPD.
  • This annual report incorporates 66 studies published January 2017-July 2018, updating 4th major revision released January 2017.

What is new

  • Poverty, HIV, indoor cookstove biomass are risk factors.
  • Cases detectable via mailed questionnaires, risk scores based on electronic health record.
  • New section on blood eosinophil counts.
  • Updates on rehabilitation, self-management, bronchoscopy, surgery.
  • Updates on long-acting beta agonists (LABA), long-acting muscarinic antagonists (LAMA), inhaled corticosteroids (ICS), and combinations: 
    • For exacerbation prevention, 2 studies favored LABA/LAMA; 1 favored LAMA over LABA/LAMA, 1 favored ICS/LABA over LABA/LAMA;
    • For slower FEV1 decline, 1 favored ICS/LABA over LABA.
  • Updated algorithms address drug initiation, follow-up; including use of peripheral eosinophil counts as biomarker.
  • Escalation, deescalation advice.
  • Revised recommendations for GOLD groups A, B, C, D.
  • When to skip noninvasive ventilation.
  • Usefulness of budesonide, intensive ICS/LABA, high-flow nasal cannula, pneumococcal vaccination.
  • Disappointing results for doxycycline, telemedicine.