COPD Management Algorithm - GOLD 2019 guidelines
Categorize into COPD GOLD A-D -> Initiate first-line therapy -> Follow-up based on further DYSPNEA or EXACERBATIONS
COPD GOLD 2019 guidelines were published in November and a few changes were included. When managing the pharmacotherapy of COPD, the first step is to categorize patients into GOLD Group A-D based on their dyspnea level and history of exacerbations. Which group they are in will tell you what to initiate as a first-line agent. See one of my previous posts about how to categorize and what to initiate (this is unchanged from GOLD 2018). What did change is the follow-up step. Instead of simply stepping up therapy from single to dual to triple, GOLD 2019 recommendations take into account whether the patient is having worsening dyspnea or exacerbations on current regimens. If dyspnea is present, recommendation is to step to dual bronchodilators or change devices (there are only 3 dual bronchodilator combo inhalers available in the US). If patient has exacerbations, you can consider initiating triple therapy which includes ICS if patients have high levels of eosinophils.
ICS use should only be used in patients who have high eosinophils. Unnecessary ICS use actually increases risk of pneumonia and patients with COPD naturally have a higher risk of pneumonia, so careful consideration of inhalers is needed.
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
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