- 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.
- 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.