The 2017 GOLD Report includes some notable changes for respiratory therapists involved in the care, treatment, and disease management of COPD patients.
Developed by an internationally-recognized group of clinicians, the updated recommendations specifically call for –
- Separation of spirometric values from the “ABCD” grouping of patients by symptoms and risk of exacerbations. According to the authors, while FEV1 is an important parameter in predicting hospitalization and mortality at the population level, keeping results separate acknowledges the limitations of FEV1 in making treatment decisions for individualized patient care and highlights the importance of patient symptoms and exacerbation risks in guiding therapies in COPD.
- Inclusion of specific escalation and de-escalation strategies for pharmacological treatments. The authors note that past GOLD reports only made initial therapy recommendations, but many patients continue to experience persistent symptoms and, though less common, in some patients symptoms resolve, indicating that they might benefit from de-escalation of therapy.
- Addition of a comprehensive review of non-pharmacologic treatment of COPD. GOLD 2017 notes the benefits of these treatments, which include pulmonary rehabilitation, exercise training, oxygen therapy, vaccinations, interventional bronchoscopy and surgery, and end-of-life and palliative care, and makes recommendations for their best use.
- Recognition that COPD often coexists with other diseases, including cardiovascular disease, osteoporosis, anxiety and depression, gastroesophageal reflux, and obstructive sleep apnea. While the authors acknowledge that these comorbidities should be treated, they also stress that the presence of comorbidities should not alter COPD treatment and that the goal of treating COPD patients with comorbidities is to ensure simplicity of treatment and minimize polypharmacy.
The report was published online ahead of print by the American Journal of Respiratory and Critical Care Medicine on Jan. 27.