GOLD publishes 2019 COPD strategy update

GOLD (Global Initiative for Chronic Obstructive Lung Disease) has updated its strategy for the diagnosis, management and prevention of COPD.

There are two key changes:

• Initial treatment (based on the ABCD assessment of symptoms tool) is separated from follow-up treatment (based on the patient’s treatable traits and currently used drugs).
• Blood eosinophil count (with a cut off of 300) is introduced as a biomarker for estimating the efficacy of inhaled corticosteroids (ICS) for the prevention of exacerbations. 

Dr Vince Mak, consultant integrated care physician, London, and PCRS Executive Committee member says:  “The initiation recommendations are still based on the GOLD ABCD quadrants as before, but they have greatly simplified all the quadrants except for D which continues to suggest three treatment options.

“The interesting new development comes in what to do on follow up.  Here, GOLD abandons ABCD, and suggests management based on treatable traits and which they call ‘predominant treatable traits’ - dyspnoea and exacerbations.  If the patient has both, exacerbations trump dyspnoea.  

The flow diagram says:

• Breathlessness:  LAMA (or LABA) - then LAMA+LABA  (no option for triple therapy)
• Exacerbations:  LAMA (or LABA) - then LAMA+LABA, then triple therapy.  

“GOLD recommends starting with monotherapy rather than jumping straight to combination LAMA+LABA.  This is based on the evidence that LAMA alone is pretty good at symptom control and reducing exacerbations, and LAMA+LABA is only marginally better (not twice as good).”

Dr Duncan Keeley, GP and PCRS Policy Lead, says: “This update is really positive and aligns closely with the PCRS consensus based article Treatment Guidelines for COPD - Going for Gold which sets out a simple treatment pathway based on the predominant characteristics of COPD for an individual – whether symptoms or exacerbations.  

“We recommend that PCRS members continue to use Going for Gold as we wait for NICE to update its 2010 COPD guidance, which is due to be published on December 5.”