COPD Guidelines Quiz: Mining for GOLD

As part of the ongoing Global Initiative for Chronic Obstructive Lung Disease (GOLD), the updated 2018 report reflects the latest evidence on implementation of effective care for patients with COPD.

The 2018 report is thought to represent only a minor update to the 2017 guidelines, but several changes in the new document will influence current and future patient care and may help improve patient outcomes.

Find out what you know about the latest revisions and recommendations for care with our short quiz.

1. The 2018 revision recommends that classification of the 4 stages of COPD be derived mainly from:

A. A patient’s “persistent” symptoms and history of exacerbations

B. The result of forced expiratory volume (FEV₁) numbers on lung function tests

C. Chest x-ray or CAT scan

D. The presence or absence of COPD-related diseases

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Answer: A. A patient’s “persistent” symptoms and history of exacerbations.

Assessment of a person’s symptoms and history of exacerbations along with lung function tests is recommended in the new guidelines because basing the 4 stages of COPD only on the FEV₁ numbers on lung function tests was thought to underestimate disease severity.

2. What new recommendation in the 2018 update is designed to account for variability and increase specificity for patients with an initial FEV₁/FVC ratio in the 0.6 to 0.8 range?

A. A single measurement of the post-bronchodilator FEV₁/FVC ratio

B. Repeat spirometry

C. Assessing the degree of reversibility of airflow limitation

D. Screening spirometry

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Answer: B. Repeat spirometry.

Assessment of the presence or absence of airflow obstruction based on a single measurement of the post-bronchodilator FEV₁/FVC ratio should be confirmed by repeat spirometry on a separate occasion if the value is between 0.6 and 0.8 because in some cases the ratio may change as a result of biologic variation when measured at a later interval. If the initial post-bronchodilator FEV₁/FVC ratio is less than 0.6, it is unlikely to rise above the spirometric criterion of 0.7 spontaneously.

3. New data in the 2018 GOLD report support the use of what kind of therapy?A. Long-acting muscarinic antagonist (LAMA)

B. Long-acting beta agonist/inhaled corticosteroid (LABA/ICS) combination

C. LAMA/LABA dual bronchodilation

D. Triple therapy with LABA/LAMA/ICS

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Answer: D. Triple therapy with LABA/LAMA/ICS.

Triple therapy is recommended for patients who experience recurrent exacerbations in spite of treatment with a dual bronchodilator (preferred initial therapy) or LABA/ICS combination (alternative initial therapy). Adding roflumilast or N-acetylcysteine may be considered for patients who have chronic bronchitis with frequent exacerbations.

4. Which respiratory treatment option below was added to the 2018 GOLD guidelines?

A. Oxygen therapy

B. High-flow oxygen therapy by nasal cannula

C. Noninvasive mechanical ventilation

D. Ventilatory support

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Answer: B. High-flow oxygen therapy by nasal cannula (HNC).

HFNC may be an alternative to standard oxygen therapy or noninvasive positive pressure ventilation for patients with acute hypoxemic respiratory failure. Studies have shown that HFNC can reduce the need for intubation or mortality in these patients. In a randomized crossover trial, HFNC improved oxygenation and ventilation and decreased hypercarbia in patients with COPD and very severe underlying disease who required supplemental oxygen.

5. In the recent SPIROMICS* analysis of how COPD treatment aligns with 2011 GOLD strategies, how many participants reported inhaler regimens that did NOT align with GOLD recommendations?

A. Fewer than 10%

B. About one-fourth

C. Just under half

D. More than three-fourths

*SubPopulations and InteRmediate Outcome Measures In COPD Study

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Answer: C. Just under half.

Uptake is poor in spite of awareness of COPD treatment recommendations; 47% did not align with 2011 or 2017 recommendations and only 35% aligned with both. Nonalignment mostly resulted from overuse of nonindicated inhaled corticosteroid regimens in milder disease and lack of long-acting inhalers in severe disease.

Sources

Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of COPD. (2018 Report)

Mirza S, Clay RD, Koslow MA, Scanlon PD. COPD guidelines: a review of the 2018 GOLD Report. Mayo Clin Proceed. 2018;93:1488-1502.

Ghosh S, Anderson WH, Putcha N, et al. Alignment of inhaled COPD therapies with published strategies: analysis of the GOLD recommendations in SPIROMICS. Ann Am Thorac Soc. 2018. Published Online September 14, 2018