scholarly journals COPD Guidelines: Old Gold versus New Gold

2018 ◽  
Vol 29 (1) ◽  
pp. 31-35
Author(s):  
HAM Nazmul Ahasan ◽  
Homayra Tahseen Hossain
Keyword(s):  
Respiratory Symptoms ◽  
Chronic Obstructive Lung Disease ◽  
International Committee ◽  
Beta Agonist ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Diagnosis And Management ◽  
Global Initiative ◽  
Personalized Approach ◽  
Long Acting

Chronic Obstructive Pulmonary Disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is an international committee of experts who periodically update the knowledge on the diagnosis and management of COPD since 2001. This year 2017, the GOLD initiative published the 5-year update on the diagnosis and management of COPD.This review article mainly highlights the differences between old GOLD versus new GOLD guideline. Compared to the previous version, this documents has been an extensively revised: the definition has been simplified, highlighting the importance of respiratory symptoms, and disease development is further discussed, including new insights on lung development. Spirometry is no longer included in the ABCD tool, which is now centered exclusively on respiratory symptoms and history of exacerbation. Subsequently, pharmacologic treatment has been shifted towards a more personalized approach. For the first time, GOLD proposes escalation strategies. Preference is given to LABA/LAMA (long-acting beta-agonist/long-acting muscarinic antagonists) combinations over LABA/ICS (long-acting beta-agonist/inhaled corticosteroid) combinations as a mainstay of treatment.Bangladesh J Medicine Jan 2018; 29(1) : 31-35

Triple Therapy in COPD

2019 ◽  
Vol 15 (2) ◽  
pp. 102-111 ◽  
Author(s):  
Claudio Micheletto ◽  
Alice Sparacino
Keyword(s):  
Triple Therapy ◽  
Treatment Options ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Glycopyrronium Bromide ◽  
Copd Patients ◽  
Global Initiative ◽  
Long Acting ◽  
The Impact

: Triple inhaled therapy for Chronic Obstructive Pulmonary Disease (COPD) includes an inhaled corticosteroid (ICS), a long-acting b2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) taken in combination. Triple therapy is recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) for patients who experience recurrent exacerbations despite treatment with either a dual bronchodilator or LABA/ICS combination. There is consistent evidence that the LABA/LAMA/ICS combination has significantly greater effects on trough FEV1, symptoms, quality of life, and exercise performance compared to comparator treatments. : The role of triple therapy in reducing exacerbations in COPD patients is debatable, but recent trials have revealed some intriguing insights. : Three pivotal studies, namely TRILOGY, TRINITY and TRIBUTE have been conducted to evaluate the safety and efficacy of extrafine Beclomethasone/Formoterol Fumarate/Glycopyrronium Bromide (BDP/FF/GB) versus different treatment options for COPD. Extrafine BDP/FF/GB has been compared to an ICS/LABA (BDP/FF) combination in the TRILOGY study, to a LAMA monotherapy (Tiotropium-TIO) and an extemporary triple combination of ICS/LABA + LAMA (BDP/FF + TIO) in the TRINITY study, and to one inhalation of LABA/LAMA per day (Indacaterol/ Glycopyrronium - IND/GLY) in the TRIBUTE study. : Another triple therapy with Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) was recently tested in two further studies that included patients with COPD. The FULFIL study compared the efficacy of the triple FF/UMEC/VI therapy to the ICS/LABA association budesonide/formoterol, while the IMPACT study compared the rate of moderate and severe exacerbations between singleinhaler FF/UMEC/VI and single-inhaler FF/VI or UMEC/VI.

scholarly journals High prevalence of undiagnosed COPD among patients evaluated for suspected myocardial ischaemia

Open Heart ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. e000848 ◽  
Author(s):  
Andreas Jönsson ◽  
Artur Fedorowski ◽  
Gunnar Engström ◽  
Per Wollmer ◽  
Viktor Hamrefors
Keyword(s):  
Myocardial Ischaemia ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive ◽  
Clinical Factors ◽  
Obstructive Pulmonary Disease ◽  
Presenting Symptoms ◽  
High Prevalence ◽  
History Of ◽  
Artery Disease ◽  
Global Initiative

ObjectiveChronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) are leading causes of global morbidity and mortality. Despite the well-known comorbidity between COPD and CAD, the presence of COPD may be overlooked in patients undergoing coronary evaluation. We aimed to assess the prevalence of undiagnosed COPD among outpatients evaluated due to suspected myocardial ischemia.MethodsAmong 500 outpatients who were referred to myocardial perfusion imaging due to suspected stable myocardial ischaemia, 433 patients performed spirometry. Of these, a total of 400 subjects (age 66 years; 45% women) had no previous COPD diagnosis and were included in the current study. We compared the prevalence of previously undiagnosed COPD according to spirometry criteria from The Global Initiative for Chronic Obstructive Lung Disease (GOLD) or lower limit of normal (LLN) and reversible myocardial ischaemia according to symptoms and clinical factors.ResultsA total of 134 (GOLD criteria; 33.5 %) or 46 patients (LLN criteria; 11.5%) had previously undiagnosed COPD, whereas 55 patients (13.8 %) had reversible myocardial ischaemia. The presenting symptoms (chest discomfort, dyspnoea) did not differ between COPD, myocardial ischaemia and normal findings. Except for smoking, no clinical factors were consistently associated with previously undiagnosed COPD.ConclusionsAmong middle-aged outpatients evaluated due to suspected myocardial ischaemia, previously undiagnosed COPD is at least as common as reversible myocardial ischaemia and the presenting symptoms do not differentiate between these entities. Patients going through a coronary ischaemia evaluation should be additionally tested for COPD, especially if there is a positive history of smoking.

scholarly journals The stability of blood Eosinophils in chronic obstructive pulmonary disease

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Gabriella H. Long ◽  
Thomas Southworth ◽  
Umme Kolsum ◽  
Gavin C. Donaldson ◽  
Jadwiga A. Wedzicha ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Chronic Obstructive Lung Disease ◽  
Predictive Biomarker ◽  
Chronic Obstructive ◽  
Blood Eosinophil ◽  
Obstructive Pulmonary Disease ◽  
Global Initiative ◽  
The Stability ◽  
Blood Eosinophils

AbstractBlood eosinophils are a predictive biomarker of inhaled corticosteroid response in chronic obstructive pulmonary disease (COPD). We investigated blood eosinophil stability over 1 year using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 thresholds of < 100, 100- < 300 and ≥ 300 eosinophils/μL in 225 patients from the COPDMAP cohort. Blood eosinophils showed good stability (rho: 0.71, p < 0.001, ICC 0.84), and 69.3% of patients remained in the same eosinophil category at 1 year. 85.3% of patients with eosinophils < 100 cells/μL had stable counts. The majority of blood eosinophil counts remain stable over 1 year using the GOLD 2019 thresholds.

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