Spirometry remains important for the diagnosis and assessment of COPD but its value in making treatment decisions has been downgraded in the latest version of the Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease.
According to Professor Peter Frith, a director on the board of the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the approach recognises the unreliability of FEV1 as a marker of disease severity at an individual patient level.
“This clarification is because of the frequent discrepancies between FEV1 levels and clinical parameters. The assessment of symptoms and exacerbation risk informs more precise treatment recommendations than spirometry.”
“For example, if you want to reduce exacerbations, then you need to look at the patient’s exacerbations history,” he said.
In the new assessment tool, patients are assigned a spirometric grade 1-4 and allocated to an ABCD group based exclusively on symptom burden and exacerbation risk.
Professor Frith told the limbic that Australian clinicians would continue to refer to the COPD-X guidelines, which were subtly different but supported by the GOLD strategy document.
“Doctors including GPs do need to be aware of the international recommendations however they won’t impact much on patients in Australia. Globally, they are much firmer and clearer in the recommendations for treatment – both initial treatment and, importantly, what to do if symptoms are not improving.”
He said the GOLD strategy also included a new and extensive chapter on COPD and comorbidities.
He highlighted the co-existence of asthma and COPD as a significant prognostic indictor for more severe disease and more rapid decline.
“Patients who have a past history of asthma in childhood or a large bronchodilator response in what otherwise looks like COPD, should be treated as per asthma guidelines first and then add in the COPD treatment.”
“We are looking much more at individuals in terms of their phenotype and I suspect as this document evolves, we will find more ways to deliver personalised treatment,” Professor Frith said.
You can access the GOLD update here.