Chronic Obstructive Pulmonary Disease (COPD)
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COPD severity is defined as a FEV1/FVC Ratio <70% post-bronchodilator
Assessment of airflow limitation
| Stage | Definition | Recommended treatments |
|---|---|---|
| 1 | FEV1 > 80% predicted | Flu and pneumonia vaccine and short acting bronchodilator (SABA) |
| 2 | 50% < FEV1 < 80% predicted | Long acting bronchodilator (LABA), anti-cholinergic and/or beta-2 agonist, pulmonary rehabilitation, mucolytic |
| 3 | 30% < FEV1 < 50% predicted | Inhaled glucocorticosteriods (ICS), or combination of inhaled glucocorticosteriods /long-acting bronchodilator beta-2 agonist, &/or Phosphodiesterase-4 inhibitor (PDE-4), mucolytic |
| 4 | FEV1 < 30% predicted | Consider non-invasive ventilation at night |
Symptom assessment: Modified MRC (mMRC) dyspnea scale
| mMRC Grade | Level of dyspnea |
|---|---|
| 0 | I only get breathless with strenuous exercise. |
| 1 | I get short of breath when hurrying on the level or walking up a slight hill. |
| 2 | I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level. |
| 3 | I stop for breath after walking about 100 meters or after a few minutes on the level. |
| 4 | I am too breathless to leave the house or I am breathless when dressing or undressing. |
Exacerbation history with assessment of symptoms/risk of exacerbation
| Group | Exacerbations in past year | mMRC Grade | Recommended treatments |
|---|---|---|---|
| A | 0-1 (no hospital admissions) | 0-1 | Bronchodilator |
| B | 0-1 (no hospital admissions) | >1 | Long-acting beta-agonist and/or long-acting muscarinic antagonist (e.g., tiatropium) |
| C | >=2 or 1 leading to hospital admission | 0-1 | Long-acting beta-agonist and/or long-acting muscarinic antagonist (e.g., tiatropium). Consider a long-acting beta-agonist with an inhaled corticosteroid. |
| D | >=2 or 1 leading to hospital admission | >1 | Long-acting beta-agonist and long-acting muscarinic antagonist (e.g., tiatropium). Consider macrolide for former smokers. Consider roflumilast if FEV1 < 50% predicted and patient has chronic bronchitis. |
2017 GOLD Guidelines for COPD diagnosis, management and prevention
April 2015 Summary of ACCP-CTS recommendations for preventing acute COPD exacerbations
April 2015 full ACCP-CTS guidelines for the prevention of acute COPD exacerbations
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