GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality. Early detection and appropriate treatment and management of COPD can lower morbidity and perhaps mortality. Clinicians in the primary care setting provide the majority of COPD care and are pivotal in the diagnosis and management of COPD. In this review, we provide an overview of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2020 report, with a focus on the management of COPD in the primary care setting. We discuss the pathophysiology of COPD; describe COPD risk factors, signs, and symptoms that may facilitate earlier diagnosis of COPD; and reinforce the importance of spirometry use in establishing the diagnosis of COPD. Disease monitoring, as well as a review of the 2020 GOLD treatment recommendations, is also discussed. Patients and families are important partners in COPD management; therefore, we outline simple steps that may assist them in caring for those affected by COPD. Finally, we discuss nonpharmacological treatment options for COPD, COPD monitoring tools that may aid in the evaluation of disease progression and response to therapy, and the importance of developing a COPD action plan on an individualized basis.

Keywords:

• COPD
• LABA
• LAMA
• primary care

Abbreviations

CAT, COPD Assessment Test; CD, Cluster differentiation; COPD, Chronic Obstructive Pulmonary Disease; COPDF, Chronic Obstructive Pulmonary Disease foundation; ED, Emergency department; FEV₁, Forced expiratory volume in 1 second; FVC, Forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, Inhaled corticosteroids; LABA, Long-acting β₂-agonist; LAMA, Long-acting muscarinic antagonist; mMRC, modified Medical Research Council; QoL, Quality of life; Tdap, Tetanus, diphtheria, and pertussis combination vaccine.

Acknowledgments

The authors meet the criteria for authorship as recommended by the International Committee of Medical Journal Editors. The authors received no direct compensation related to the development of the manuscript. Writing, editorial support, and formatting assistance were provided by Suchita Nath-Sain, PhD, Michelle Rebello, PhD, and Maribeth Bogush, PhD, of Cactus Life Sciences (part of Cactus Communications), which was contracted and compensated by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI) for these services. BIPI was given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations.

Author Contributions

All authors made a significant contribution to the conception and interpretation of the article; took part in critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

BPY served on advisory boards for Boehringer Ingelheim, AstraZeneca, TEVA, and GlaxoSmithKline (GSK) and received consulting fees from GSK related to COPD; and received grants from the COPD Foundation, Boehringer Ingelheim, and National Heart, Lung, and Blood Institute (NHLBI), outside the submitted work. MLM received speaking and consulting fees from GSK, Mylan, and Boehringer Ingelheim, outside the submitted work. DED served on advisory boards and received speaker fees from AstraZeneca and Boehringer Ingelheim and received grants from Boehringer Ingelheim and NHLBI outside of the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

Writing, editorial support, and formatting service for this review was funded by Boehringer Ingelheim Pharmaceuticals, Inc.