GOLD Flashcards
What are the symptoms of COPD?
- Dyspnea (shortness of breath)
- Recurrent wheezing
- Chronic cough (cough that lasts 8 weeks or more)
- Repeat lower respiratory tract infections
- Previous history of smoking or exposed to smoke/dust/flames
What is used to diagnose COPD?
A spirometer
How is a Spirometry used?
Patient is given 400mcg short beta agonist (salbutamol) then measure in 15 mins.
It measures:
- Total volume of air able to breathe out in one second (FEV1 - forced expiratory volume in 1 sec)
- Total volume of air able to breathe out in one breath (FVC - forced vital capacity)
FEV1 & FVC results are from the spirometer.
Then the results is compared to someone of the same:
- Age
- Height
- Sex
- Race
which helps to show if the lungs are working properly.
What result confirms COPD?
FEV1 / FVC ratio of less than 0.7 confirms COPD.
What calculations are needed for the GOLD ABE assessment tool?
Need to calculate:
- FEV1/FVC ratio (used to find GOLD grade)
- mMRC
- CAT
- eCOPD (exacerbation of COPD)
Then patients are placed into their respective groups (A, B or E) and are GOLD graded
Explain the GOLD grades?
GOLD 1: Mild: FEV1 >= 80% predicted
GOLD 2: Moderate: 50% <= FEV1 < 80% predicted
GOLD 3: Severe: 30% <= FEV1 < 50% predicted
GOLD 4: Very severe: FEV1 < 30% predicted
When are patients GOLD graded?
When the FEV1/FVC is under 0.7
What are the different groups of the GOLD assessment tool and how do they work?
Group A
- Moderate or Severe exacerbation history = 0 or 1 (not leading to hospital admission)
- mMRC 0 or 1
OR CTA less than 10
Group B
- Moderate or Severe exacerbation history = 0 or 1 (not leading to hospital admission)
- mMRC >=2
OR CAT >=10
Group E
- Moderate or Severe exacerbation history = >=2 or 1 leading to hospital admission
- mMRC 0 or 1 or CAT <10
- mMRC >=2 or CAT >=10
So basically for Grade E, if it led to hospital admissions, it’s grade E.
What does mMRC stand for?
Modified medical research council
It grades patients from 0-4 based on their symptoms and breathlessness.
Grade 0-1 means Group A or E.
Grade 2 or more means Group B or E.
Explain the CAT test and results?
It’s questions for patients and each question is a score of 0-5.
Patients lowest score can be 0 and highest possible score is 40.
CAT score less than 10 placed in A or E depending on exacerbations.
CAT score 10 or more placed in B or E depending on exacerbations.
Explain what eCOPD is?
Exacerbation history per year.
Group E - 1 or more exacerbations that led to hospitalization.
Group A&B - 0-1 moderate exacerbation not leading to hospitalization.
What is the initial treatment for each GOLD grade?
Group A
- A bronchodilator
Group B
- LABA + LAMA*
Group E
- LABA + LAMA*
(consider LABA + LAMA + ICS, if blood eos is >= 300)
- but not if a single inhaler therapy is more convenient and effective than multiple inhalers
What should be done if initial treatment is not effective?
- Check adherence, inhaler technique and possible interfering comorbidities.
- Consider the predominant treatable trait to target dyspnea or exacerbations.
If both dyspnea and exacerbation needs to be targeted, use exacerbation pathway. - Follow the indications and assess response. Adjust and review.
The pathways do not depend on the ABE assessment at diagnosis.
What is the Dyspnea pathway?
- LABA or LAMA
- Assess LABA or LAMA and see if single inhaler therapy is more convenient and effective.
If still not
3. Consider switching inhaler devices or molecules.
4. Implement non-pharmacological treatments.
- Investigate and treat other causes of dyspnea.
What is the Exacerbation pathway?
- LABA or LAMA
- If blood eos is less than 300 then assess LABA or LAMA and see if single inhaler therapy is more convenient and effective. If blood eos becomes higher than 300 then add ICS.
If blood eos is more than 300 then LABA + LAMA + ICS.
Consider de-escalation of ICS if pneumonia or other considerable side effects occur.
If blood eos becomes more than 300 then the removal of ICS is most likely linked to the development of exacerbation.
- If blood eos is less than 100, or the addition of ICS was ineffective then add either Roflumilast or Azithromycin.
Roflumilast - if FEV1 less than 50% and has chronic bronchitis.
Azithromycin - if a former smoker.
