Joint statement for the diagnosis, management, and prevention of chronic obstructive pulmonary disease for Gulf Cooperation Council countries and Middle East–North Africa region, 2017

Figures & data

Figure 1 Spirometry showing normal (A) and obstructive (B) patterns.

Table 1 Classification of severity of airflow obstruction in COPD (based on postbronchodilator FEV₁) in patients with FEV₁/FVC <0.7

GOLD I	Mild	FEV1 ≥80% predicted
GOLD II	Moderate	≥50% FEV0 <80% predicted
GOLD III	Severe	≥30% FEV1 <50% predicted
GOLD IV	Very severe	FEV1 <30% predicted

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Figure 2 Refined ABCD assessment tool (simpler version).

Abbreviations: mMRC, modified Medical Research Council (dyspnea scale); CAT, COPD-assessment test.

Table 2 Criteria for diagnosis of asthma–COPD overlap syndrome

Major	Minor
1. Persistent airflow limitation (postbronchodilator FEV1/FVC)	1. Documented history of atopy or allergic rhinitis
2. At least 10 pack-years of tobacco smoking or equivalent indoor/outdoor air-pollution exposure (eg, biomass)	2. BDR on FEV1 ≥200 mL and 12% from baseline values on two or more visits
3. Documented history of asthma before 40 years of age or BDR of >400 mL on FEV1	3. Peripheral blood eosinophil count of ≥300 cells/μL

Note:

* The committee recommends presence of all three major criteria and at least one minor criterion for asthma–COPD overlap syndrome.

Abbreviations: FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; BDR, bronchodilator responsiveness.

Table 3 Differential diagnosis of COPD

Diagnosis	Suggestive features
COPD	Onset usually in midlife
	Slowly progressive symptoms
	History of exposure to risk factors
Asthma	Onset usually in early life
	Variable symptoms that worsen at night and early morning
	Other allergic conditions may be present
	Family history of asthma may be present
Congestive heart failure	History of cardiac disease
	Dilated heart on chest X-ray
	No airflow limitation
Bronchiectasis	Large volume of sputum
	Chest CT demonstrates bronchial dilatation
Tuberculosis	Radiological lung infiltrates
	Microbiological confirmation

Abbreviation: CT, computed tomography.

Table 4 Key principles of initial pharmacological management

Identify patients with frequent exacerbations*

Frequent exacerbators may start with either LAMA–LABA or ICS–LABA

Factors favoring ICS–LABA include high blood-eosinophil count and asthma features

Patients with low exacerbation frequency usually commence on LAMA

Note:

* Two exacerbations requiring oral steroids and/or antibiotics or one hospitalization in the previous year.

Abbreviations: LAMA, long-acting muscarinic antagonist; LABA, long-acting β₂-agonist; ICS, inhaled corticosteroid.

Figure 3 Initial pharmacological treatment for new patient.

Notes: Patients with few symptoms (CAT <10 or mMRC 0–1) may be managed with a short-acting bronchodilator. Patients with high symptom burden may be initially treated with LAMA/LABA. Patients with fewer symptoms (CAT <10 or mMRC 0–1) may initially be treated with LAMA. ³ICS–LABA combination would be preferred in ACOS patients.
Abbreviations: mMRC, modified Medical Research Council (dyspnea scale); CAT, COPD-assessment test; LAMA, long-acting muscarinic antagonist; LABA, long-acting β₂-agonist; ICS, inhaled corticosteroid; ACOS, asthma–COPD overlap syndrome.

Table 5 Key principles of follow-up pharmacological management

Treatment of symptoms (without exacerbations) requires addition of a long-acting bronchodilator

Treatment of symptoms and exacerbations requires addition of either a long-acting bronchodilator or inhaled corticosteroid

Two exacerbations in the previous year or one exacerbation/year for

2 years should be used as a threshold to escalate treatment

Switching ineffective treatments should be considered

Inhaler technique and compliance should be continuously monitored

Figure 4 Follow-up treatment of COPD patients.

Abbreviations: LAMA, long-acting muscarinic antagonist; LABA, long-acting β₂-agonist; ICS, inhaled corticosteroid.