Chronic COPD- ABCD Assessment Tool

Question 1

Steps in the ABCD assessment

Answer 1

Spirometry performed and COPD diagnosis confirmed

Assessment of airflow limitation

Assessment of symptoms/risk of exacerbations

Question 2

FEV1/FVC ratio needed post-bronchodilator to diagnose COPD

Answer 2

<0.7

Question 3

GOLD 1 classification (level of severity and FEV1 result)

Answer 3

Mild, FEV1 ≥80% predicted

Question 4

GOLD 2 classification

Answer 4

Moderate, FEV1 is ≥50% but <80% of predicted

Question 5

GOLD 3 classification

Answer 5

Severe, FEV1 is ≥30% but <50% of predicted

Question 6

GOLD 4 classification

Answer 6

Very severe, FEV1 is <30% of predicted

Question 7

How are COPD exacerbations classified?

Answer 7

Mild- only need SABAs
Moderate- need SABAs plus ABX and/or PO corticosteroids
Severe- patient requires hospitalization or visits the ER

Question 8

What can also predict exacerbation rates?

Answer 8

Blood eosinophil count in patients treated with a LABA/ICS, it’s a marker for more severe disease

Question 9

ABCD assessment: characteristics of someone who falls into category A

Answer 9

0-1 exacerbations or not leading to hospitalization
mMRC 0-1, CAT <10

Question 10

ABCD assessment: characteristics of someone who falls into category B

Answer 10

0-1 exacerbations or not leading to hospitalization
mMRC ≥2, CAT ≥10

Question 11

ABCD assessment: characteristics of someone who falls into category C

Answer 11

≥2 moderate or severe exacerbations or ≥1 leading to hospitalization
mMRC 0-1, CAT <10

Question 12

ABCD assessment: characteristics of someone who falls into category D

Answer 12

≥2 moderate or severe exacerbations or ≥1 leading to hospitalization
mMRC ≥2, CAT ≥10

Question 13

Treatment for category A

Answer 13

Any bronchodilator (LABAs or LAMAs preferred)

Question 14

Treatment for category B

Answer 14

LABA or LAMA

Question 15

Treatment for category C

Answer 15

LAMA

Question 16

Treatment for category D

Answer 16

LAMA
LAMA/LABA if CAT >20
ICA/LABA if eosinophils ≥300

Question 17

Adjusting therapy when the patient has dyspnea: if they’re on a LABA or LAMA, what do you do?

Answer 17

LABA/LAMA combo; if that doesn’t work, consider switching inhaler device or molecules, investigate and treat other causes of dyspnea

Question 18

Adjusting therapy when the patient has dyspnea: if they’re on a LABA+ICS, what do you do?

Answer 18

Go to LABA/LAMA or LABA/LAMA/ICS

Question 19

When to de-escalate ICS

Answer 19

If the patient has pneumonia, inappropriate original indication, lack of response to ICS

Question 20

Adjusting therapy when the patient has dyspnea: if they’re on triple therapy, what do you do?

Answer 20

Switch to LABA/LAMA or consider switching inhaler device or molecules and treat other causes of dyspnea if there are any

Question 21

Adjusting therapy when the patient has an exacerbation: if they’re on a LABA or LAMA, what do you do?

Answer 21

Switch to LABA/LAMA or LABA/ICS if the eos ≥300 or eos ≥100 AND ≥2 moderate exacerbations/1 hospitalization

Question 22

Adjusting therapy when the patient has an exacerbation: if they’re on a LABA/LAMA, what do you do?

Answer 22

Go to triple therapy if eos ≥100
Consider roflumilast if FEV1 <50%, has chronic bronchitis, and eos <100
Consider azithromycin in former smokers and eos <100

Question 23

Adjusting therapy when the patient has an exacerbation: if they’re on a LABA/ICS, what do you do?

Answer 23

Switch to triple therapy or de-escalate ICS to LABA/LAMA combo if they have pneumonia, inappropriate original indication, or lack of response to ICS

Question 24

Adjusting therapy when the patient has an exacerbation: if they’re on triple therapy, what do you do?

Answer 24

De-escalate to LABA/LAMA combo, consider roflumilast or azithromycin