Professor David Halpin highlights key learnings for primary care from the updated GOLD strategy for chronic obstructive pulmonary disease
Read the related Guidelines summary
Implementation actions for STPs and ICSs
written by Dr David Jenner, GP, Cullompton, Devon
The following implementation actions are designed to support STPs and ICSs with the challenges involved with implementing new guidance at a system level. Our aim is to help you consider how to deliver improvements to healthcare within the available resources.
- Ensure that the 2020 GOLD report is circulated to all relevant clinicians, especially GPs and COPD specialist nurses in primary and secondary care
- Update local formularies with the revised recommendations for inhaled therapies and that ensure triple agent inhalers (LABA/ICS/LAMA) are included
- Consider autoconsultation proformas for use in primary care as prompts for required actions and tests on diagnosis and follow up
- Commission responsive services for pulmonary rehabilitation and (with local public health departments) smoking cessation services
- Recognise that people with COPD are at greater risk of mortality from COVID-19; ensure that these patients are kept updated with Public Health England advice.
STP=sustainability and transformation partnership; ICS=integrated care system; COPD=chronic obstructive pulmonary disease; LABA=long-acting beta2 -agonist; ICS=inhaled corticosteroid; LAMA=long-acting muscarinic antagonist; COVID-19=coronavirus disease 2019.
After reading this article, ‘Test and reflect’ on your updated knowledge with our patient scenarios. We estimate that this activity will take you 30 minutes—worth 0.5 CPD credits.
1. British Lung Foundation. Chronic obstructive pulmonary disease (COPD) statistics. statistics.blf.org.uk/copd (accessed 30 January 2020).
2. NICE. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE Guideline 115. NICE, 2018 (updated 2019). Available at: www.nice.org.uk/guidance/ng115
3. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2020 report. GOLD, 2019. Available at: goldcopd.org/gold-reports/
4. Global Initiative for Chronic Obstructive Lung Disease (GOLD).Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2017 report. GOLD, 2017. Available at: goldcopd.org/archived-reports/
5. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2019 report. GOLD, 2018. Available at: goldcopd.org/archived-reports/
6. Jones P, Harding G, Berry P et al. Development and first validation of the COPD Assessment Test. Eur Respir J 2009; 34 (3): 648–654.
7. Fletcher C. Standardised questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score). BMJ 1960; 2: 1662.
8. Lipson D, Barnhart F, Brealey N et al. Once-daily single-inhaler triple versus dual therapy in patients with COPD. N Engl J Med 2018; 378 (18): 1671–1680.
9. Vestbo J, Fabbri L, Papi A et al. Inhaled corticosteroid containing combinations and mortality in COPD. Eur Respir J 2018; 52 (6). doi: 10.1183/13993003.01230-2018.
10. Nolan C, Kaliaraju D, Jones S et al. Home versus outpatient pulmonary rehabilitation in COPD: a propensity-matched cohort study. Thorax 2019;74 (10): 996–998.
11. Spruit M, Singh S, Garvey C et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188 (8): e13–64.
12. Raluy-Callado M, Lambrelli D, MacLachlan S, Khalid J. Epidemiology, severity, and treatment of chronic obstructive pulmonary disease in the United Kingdom by GOLD 2013. Int J Chron Obstruct Pulmon Dis 2015;10: 925–937.
13. Sivapalan P, Ingebrigtsen T, Rasmussen D et al. COPD exacerbations: the impact of long versus short courses of oral corticosteroids on mortality and pneumonia: nationwide data on 67 000 patients with COPD followed for 12 months. BMJ Open Respir Res 2019; 6 (1): e000407.
14. Waljee A, Rogers M, Lin P et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ 2017; 357: j1415.
15. Jolliffe D, Greenberg L, Hooper R et al. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials. Thorax 2019; 74 (4): 337–345.