In this article we review the major changes in the 2023 GOLD report as they impact on the initial and ongoing pharmacological management of COPD and consider the implications for primary care in the UK. Dr Fiona Mosgrove is a GP in Aberdeen and Clinical Lead for the Grampian Respiratory Improvement Programme. Dr Tracey Lonergan is the Policy Coordinator for the Primary Care Respiratory Society and Medical Writer with a special interest in respiratory disease.
The high rate of empirical antibiotic use for the treatment of suspected respiratory tract infections (RTIs) and COPD exacerbations remains a cause for concern in the face of increasing antibiotic resistance.
PCRS have issued a position statement on strategies to care for patients with respiratory disease and frailty in the community setting. Frailty is thought to affect around 10% of those aged over 65 years and up to half of those aged over 85 years. The health and social care needs of these vulnerable patients can be complex and require a holistic approach that should involve confirmation of current diagnoses and review of all medications giving consideration to the goals of treatment, likely benefits and likely side effects.
In this article Angela Wixey discusses a local programme of work that was established to unravel the risk factors associated with under- and over- diagnosis of COPD. The service was operated by a Respiratory Nurse Specialist (RNS) credited by the Association of Respiratory Technology and Physiology (ARTP) in spirometry who examined 375 patients in five practices across the county over 9 months.
Point-of-care testing of C-reactive protein (CRP) for the acute assessment of worsening symptoms in people known to have COPD can safely reduce the use of antibiotics and could help improve the diagnostic approach towards someone presenting in such a crisis. New high-quality evidence has emerged since the last NICE COPD update and we encourage re-opening and review of the current guideline to enable clinicians and system leaders to understand whether and how to implement this promising diagnostic aid.
Noel Baxter PCRS Policy Lead and Tracey Lonergan PCRS Policy Coordinator.