Update to COPD Guidelines May Benefit You
Last updated: September 2023
Editor's Note: Always talk with your doctor before altering your drug schedule or if you have any concerns regarding your treatment.
In the early 1990s, some of the world's most renowned COPD experts gathered and compiled all the data from all the COPD studies completed until then. They used this data to create COPD guidelines.
These guidelines are used today to help guide physicians on the best paths to diagnosing and managing their COPD patients. They help guide physicians on how best to help YOU manage your COPD.1
The COPD guidelines that I am most familiar with are the GOLD COPD guidelines. GOLD is an acronym for Global Initiative For Chronic Obstructive Lung Disease.1
The first edition was published in 1997. Since then, there have been various updates, the most recent in January 2023.
Some of the new updates include the following:
What inhalation devices are right for you?
There are various devices that your doctor may prescribe for you to use. One update is meant to help your doctor determine which decision is best for you.2
Dry powder inhalers (DPI)
These inhalers require powerful inhalation to get the medicine to your airways. So, these should only be prescribed to people with COPD who can generate a “powerful inhalation.” A good example of a DPI is the Advair Discus.
Metered dose inhaler (MD)
These require you to generate a slow and deep inhalation. MDIs also require you to coordinate the puff of the inhaler with your inhalation.
An MDI may be ideal if a doctor determines that you can do this. Examples of an MDI are Ventolin and Symbicort.
Slow mist inhaler
These are the newest inhalers on the market. They generate a slow mist to inhale.
Like MDIs, they require coordination and the ability to generate a slow and deep inhalation. Examples here are Spiriva and Stiolto Respimat.
These are ideal for anyone who has trouble with any of the above-mentioned inhalers. A breathing treatment creates a mist that you inhale over a period of time.
So, inhaling the medicine does not require coordination, nor does it require a specific speed of inhalation.
Lung volume reduction surgery
This surgery is indicated if you have bullae in your lungs. These are large air pockets in your lungs due to emphysema. Getting these taken care of can help you breathe easier and live longer.
What type of medicine is best for you?
The guidelines recommend that doctors prescribe for each patient one inhaler. This is because it's easier to manage one inhaler than two or three.
For those prone to flare-ups, inhalers containing two medicines are recommended. If one inhaler is not enough, the guidelines recommend stepping up to combination inhalers that contain a long-acting beta-agonists (LABA) plus a long-acting muscarinic agent (LAMA).2
Examples here include Stiolto Respimat, Anoro Elipta, and Utibron Neohaler.
Those recommendations have not changed. The change comes with the use of steroid inhalers. The latest recommendation suggests that if a person is prone to having exacerbations (flare-ups), that patient should step up to a triple inhaler that contains a LABA plus LAMA plus steroid. An example here is the inhaler Trelegy.2
What therapies help the quality of life?
The latest updates suggest that all of the following are shown to help the quality of life once diagnosed with COPD.2
Use of triple inhaler therapy
These include using a steroid, plus a LABA, plus a LAMA. These can all be given individually in a nebulizer. Or they are all contained in inhalers such as Trelegy.
Quitting smoking, no matter when you quit, is proven to help you live longer and have a better quality of life.
Long-Term Oxygen Therapy
If your oxygen levels drop below 88%, you qualify for home oxygen therapy. Inhaling oxygen every day is shown to help you live longer.
This is a device that applies pressure to your airway. It is applied to your face by a mask or nasal pillows and is usually only used while sleeping.
The pressures make it so you take effective breaths while you are sleeping. It also helps ensure that your oxygen levels remain at safe levels while you are sleeping.
Computed Tomography (CT) may be used more often
The updates emphasize the use of CT, even in the early stages of COPD. These scans can give a doctor a more detailed picture of what is happening inside your lungs than a regular X-ray.
They can aid a physician in determining if you have COPD. They can help a doctor determine the severity of our disease.
They can also help a doctor determine if you have other lung diseases, such as bronchiectasis. They may also help a doctor determine if you may benefit from surgical procedures such as lung volume reduction surgery and endobronchial valve systems (such as Zephyr Valves).2
What do you think?
So, these are just some of the changes to the GOLD COPD Guidelines. As doctors in your area become familiar with the latest recommendations, you may hear new ideas to help you feel better.
Where do you stand with your COPD?