Changes in GOLD 2018 guidelines.pdf

Changes in GOLD 2018 guidelines There are some minor changes in GOLD 2018 guidelines which is updated version of GOLD 2017 guidelines. Some of these key changes are mentioned below.

Chapter 1 updates-

1. There is a synergistic interaction between smoking and infant respiratory infections as well as early life overcrowding with lung function at age 43. 2. Cross sectional analysis showed an association between ambient level of particulate matter matter (PM 2.5/10) & COPD COPD prevalence) Chapter -2 Updates

1. Assessment of presence or absence of airflow obstruction should be confirmed by repeat spirometry on separate occasion.

Chapter 3-Updates

1. Legislative smoking bans are effective in increasing quit rates an d reducing harm from second hand smoke exposure. 2. Combination of LABA/LAMA had the greatest improvement in quality of life compared with placebo or its individual components in patients with highest baseline symptom burden. 3. Extrafine fixed triple therapy had clinical benefits compared with tiotropium in COPD patients with history of exacerbations & FEV1 <50 % 4. In patients with advance COPD Single inhaler triple therapy was reported to be beneficial to ICS/LABA therapy. 5. Greater benefits of Roflumilast in COPD patients with prior history of hospitalization for an acute exacerbation. 6. In COPD patients’ prone to exacerbations, Azithromycin (250 mg/day or 500 mg 3 times a week) or erythromycin (500 mg 2 times per day) for one year reduced the risk of exacerbation versus usual care.

7. Azithromycin (250mg/day or 500 mg 3 times a week) or erythromycin (500 mg 2 times per day) for one year reduced risk of exacerbation in COPD patients more prone to exacerbation.

8. Home based pulmonary rehabilitation program may be an equivalent alternative for patients who cannot access outpatient based pulmonary rehabilitation facility. 9. Use of CPAP(Continuous positive airway pressure) is associated with improvement in survival and risk of hospital admission in patients with both COPD and Obstructive sleep apnea.

Chapter 4-Updates

1. A short-term exposure to pollution particulate matter of PM 2.5 is associated with increases hospitalization for acute exacerbation and mortality for COPD.

2. In patients with acute hypoxemic respiratory failure patients, high flow oxygen therapy by nasal cannula (HFNC) may be an alternative to standard oxygen therapy or noninvasive positive pressure ventilation.

Glossary Word

Meaning

Synergistic

Combined effect of two or more substance. It is the sum of all solid and liquid particles suspended in air many of which are hazardous. Blockage in any part of the airway that prevents air from getting into lungs. Baseline Symptoms are symptoms that are present when the patient starts treatment (e.g., Cycle 1 Day 1 pre-dosing). Pulmonary rehabilitation is a program of exercise, education, and support to help patients learn to breathe—and function—at the highest level possible Continuous positive airway pressure (CPAP) therapy uses a machine to help a person who has obstructive sleep apnea (OSA) breathe more easily during sleep.

Particulate matter

Airflow obstruction

Baseline symptoms

Pulmonary Rehabilitation

CPAP

Hypoxemic respiratory failure

Nasal Cannula

Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide or both cannot be kept at normal levels The nasal cannula (NC) is a device used to deliver supplemental oxygen or increased airflow to a patient or person in need of respiratory help