ABCD Assessment Tool Part 2: Managing Your COPD
So, in part 1, I described the ABCD Assessment Tool. In this post, I’m going to describe how this tool is used to help your doctor best treat your COPD. This is all according to the 2018 Global Initiative For Chronic Obstructive Lung Disease (GOLD) COPD Guidelines. Here’s what to know.
If you haven’t done so already, read part 1. Write down your letter. Then come back here. Good. Now we all have a letter. Now we can use it to see what the guidelines say about treating your COPD.
So, what treatment is recommended for you? Keep in mind that these are just guidelines. Your doctor always gets to make the final decision. You also get a say. So, you and your doctor may have other ideas for how best to treat you. The goal, in either case, is to reduce both your symptoms and your risk of having a flare-up. Obviously, the goal is also to prevent hospitalizations. It's also to prevent re-admissions if you've already been admitted.
What the guidelines recommend
That said, here’s what the guidelines recommend. Next to each letter is how you are affected by COPD. What is your risk of having symptoms? What is your risk for flare-ups? This is followed by a recommendation for how best to treat you.
A. You have a low risk for symptoms. You have a low risk for flare-ups.
You only experience symptoms some of the time. You are able to do most of the things you want to do on any given day. You are usually able to manage your symptoms on your own at home. The recommended first treatment for you is a short-acting beta agonist (SABA) like Ventolin, Proventil, ProAir, or Xopenex. If needed, your doctor may consider a long-acting beta agonist (LABA) like Serevent, Arcapta, or Striverdi.
B. You have an increased risk of developing symptoms. You have a low risk for flare-ups.
You may experience symptoms every day. But, you usually don’t have flare-ups. The recommended treatment here is long-acting bronchodilators. Your doctor may prescribe a LABA like Serevent. Or, your doctor may prescribe a long-acting muscarinic antagonist (LAMA) like Spiriva, Tudorza, Seebri, or Incruse. If needed, your doctor may prescribe both of these types of bronchodilators. Your doctor may also prescribe combination inhalers that contain both a LABA and LAMA, such as Stiolto, Anoro, or Utibron.
C. You have a low risk for symptoms. But, you have a high risk for flare-ups.
A front-line treatment here is a LAMA. If you continue to experience symptoms, your doctor may prescribe a LAMA and a LABA. Another option is a LABA plus an inhaled corticosteroid (ICS) like Flovent. There are also combination inhalers here to consider that contains all of these combinations. For instance, Stiolta contains both a LABA and a LAMA. Advair and Symbicort both contain a LABA and ICS. So, there are many options to choose from here.
D. You have a high risk for symptoms. You have a high risk for flare-ups.
You experience symptoms every day. They limit your ability to stay active. Even going to the bathroom or brushing your teeth may take lots of effort. Here is where your doctor may get more aggressive with treatment. All of the above may be tried. They may have already been tried and failed. So, the next step is to try a combination of a LABA, LAMA, and ICS. A combination inhaler that contains all three (like Trelegy) may prove helpful. If this fails to work, your doctor may step up treatment once again. Your doctor may consider riflumilast if you have chronic bronchitis with a lung function less than 50%. Your doctor may also prescribe antibiotics called macrolides.
What are other options?
Other options are always available. For instance, regardless of your letter, COPD education is always helpful. Re-evaluating your inhaler technique may prove helpful. Influenza and pneumonia vaccines should be offered to you. Physical therapy may help improve your COPD control if your letter is B-D. So, these are some other options that may help reduce your symptoms and risk for future flare-ups.1 And, again, you and your doctor may also consider other options.
A tool for you and your doctor
So, this ABCD Assessment tool can help you and your doctor manages your COPD. Any of the above-mentioned therapies are top-line options for COPD. Your doctor should assess how you’re doing at each visit. Your letter should be re-evaluated. If you move from a D to an A, your treatment may be “de-escalated.” If you moved in the other direction, your treatment may be “escalated.”1
So, this is how your letter can help your doctor decide how best to treat you on a daily basis.
Have you ever had to educate a doctor?