Optimizing care of your patients with COPD

Figures & data

Figure 1 Lung Function Questionnaire and self-scored COPD Population Screen Questionnaire.

Notes: (A) Lung Function Questionnaire. Data from Hanania et al.¹¹ Reprinted with permission © Copyright 2009 GlaxoSmithKline. All rights reserved. (B) Self-scored COPD Population Screen Questionnaire. Martinez FJ, Raczek AE, Seifer FD, et al, COPD-PS Clinician Working Group. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD, 2008;5(2):85–95, copyright © 2008, Informa Healthcare. Reproduced with permission of Informa Healthcare.¹² Patients (n=113) with spirometry-confirmed airway obstruction had a mean score (± standard deviation) of 6.76±1.94 on this questionnaire.
Abbreviations: COPD, chronic obstructive pulmonary disease; n, number.

Figure 2 COPD Assessment Test. Data from Hones et al.¹³

Note: Copyright GlaxoSmithKline. Used with permission.
Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 3 Modified Medical Research Council Questionnaire for Assessing the Severity of Breathlessness.

Note: From the Global Strategy for Diagnosis, Management, and Prevention of COPD, 2013, available from http://www.goldcopd.org.⁷ Used with permission.
Abbreviation: mMRC, modified Medical Research Council.

Table 1 Classification of the severity of airflow limitation in COPD (based on postbronchodilator FEV₁)

In patients with FEV1/FVC <0.70
GOLD 1	Mild	FEV1 ≥80% predicted
GOLD 2	Moderate	50%≤ FEV1 <80% predicted
GOLD 3	Severe	30%≤ FEV1 <50% predicted
GOLD 4	Very severe	FEV1 <30% predicted

Note: From the Global Strategy for Diagnosis, Management, and Prevention of COPD, 2013, available from http://www.goldcopd.org.⁷ Used with permission.

Abbreviations: COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, The Global Initiative for Chronic Obstructive Lung Disease.

Figure 4 Assessment of COPD using symptoms, spirometric staging, and risk of exacerbations.

Note: From the Global Strategy for Diagnosis, Management, and Prevention of COPD, 2013, available from http://www.goldcopd.org.⁷ Used with permission.
Abbreviations: GOLD, The Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified Medical Research Council; CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease.

Table 2 Pharmacotherapy of COPD based on the patient’s grade of disease*

Patient group	First choice	Second choice	Alternative choice**
A	Short-acting anticholinergic prn or Short-acting beta2-agonist prn	Long-acting anticholinergic or Long-acting beta2-agonist or Short-acting beta2-agonist and short-acting anticholinergic	Theophylline
B	Long-acting anticholinergic or Long-acting beta2-agonist	Long-acting anticholinergic and long-acting beta2-agonist	Short-acting beta2-agonist and/or Short-acting anticholinergic Theophylline
C	Inhaled corticosteroid + long-acting beta2-agonist or Long-acting anticholinergic	Long-acting anticholinergic and long-acting beta2-agonist	Phosphodiesterase-4 inhibitor Short-acting beta2-agonist and/or Short-acting anticholinergic Theophylline
D	Inhaled corticosteroid + long-acting beta2-agonist or Long-acting anticholinergic	Inhaled corticosteroid and long-acting anticholinergic or Inhaled corticosteroid + long-acting beta2-agonist and long-acting anticholinergic or Inhaled corticosteroid + long-acting beta2-agonist and phosphodiesterase-4 inhibitor or Long-acting anticholinergic and long-acting beta2-agonist or Long-acting anticholinergic and phosphodiesterase-4 inhibitor	Carbocysteine Short-acting beta2-agonist and/or Short-acting anticholinergic Theophylline

Notes: GOLD patient stages are shown in Figure 4;

* medications in each box are mentioned in alphabetical order, and therefore not necessarily in order of preference;

** medications in this column can be used alone or in combination with other options in the first and second columns. From the Global Strategy for Diagnosis, Management, and Prevention of COPD, 2013, available from http://www.goldcopd.org.⁷ Used with permission.

Abbreviations: COPD, chronic obstructive pulmonary disease; prn, pro re nata (as needed); GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 3 Patients for whom nebulized therapy might be beneficial

Cognitively impaired Impaired manual dexterity Muscle weakness Unable to follow directions or noncompliant Inadequate symptom relief with an inhaler Patient’s preference

Note: Data from Dhand et al.⁴¹

Table 4 Optimizing care for COPD patients

Prevent ∘ Smoking cessation and avoid exposures to environmental tobacco smoke and other air pollutants ∘ Respiratory infections (vaccination) Suspect and diagnose ∘ I dentify patients at risk (history of smoking, environmental or occupational exposures with shortness of breath, sputum production, and/or chronic cough) ∘ Investigate Intervene early ∘ Early intervention produces better results ∘ Use of pulmonary rehabilitation for disabling symptoms Manage attentively ∘ Regular, consistent follow-up ∘ Look for signs of worsening (for example, increased rescue use, worsening of symptoms, decline in function, hypoxemia) ∘ Assess adherence and inhaler technique at every visit ∘ Consider nebulization for physically/cognitively impaired, elderly, or frail patients who may have trouble with adherence Manage within scope of comorbidities ∘ Pay attention to COPD; do not let other conditions (hypertension, diabetes, hypercholesterolemia, and so on) take all the time spent with a patient

Abbreviation: COPD, chronic obstructive pulmonary disease.

Hanania NA, Mannino DM, Yawn BP, et al. Predicting risk of airflow obstruction in primary care: Validation of the lung function questionnaire (LFQ). Respir Med. 2010;104(8):1160–1170.

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Martinez FJ, Raczek AE, Seifer FD, et al. COPD-PS Clinician Working Group. Development and initial validation of a self-scored COPD Population Screener Questionnaire (COPD-PS). COPD. 2008;5(2):85–95.

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Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline LN. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648–654.

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Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (Updated 2013). Global Initiative for Chronic Obstructive Lung Disease, Inc; Vancouver, Washington 2013.

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Dhand R, Dolovich M, Chipps B, Myers TR, Restrepo R, Farrar JR. The role of nebulized therapy in the management of COPD: evidence and recommendations. COPD. 2012;9(1):58–72.

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