The 2022 GOLD report has for the first time advised patients with COPD to follow basic infection control measures over winter to prevent exacerbations, in light of evidence gathered over the COVID-19 pandemic.
The report, Global Strategy for the Diagnosis, Management and Prevention of COPD, now includes shielding measures – such as mask wearing, minimising social contact and frequent hand-washing – within the list of interventions that prevent the frequency of COPD exacerbations.
According to Professor John Hurst, a Respiratory Consultant at Royal Free London NHS Foundation Trust, the recommendation around infection control is important given the 50% reduction in COPD hospitalisations seen in 2020, which data suggests is most likely due to patients shielding over the period.
“The reduction in hospitalised exacerbations seen during the pandemic is of greater magnitude than any other interventions we have, so it’s great to see GOLD recommend discussing these with patients to reduce future exacerbation burden,” he told the limbic.
Also welcoming publication of the report, Professor Charlotte Bolton, Chair of the COPD Specialist Advisory Group for the British Thoracic Society, said while reduction in COPD hospital admissions is an important observation, discussion with patient groups is needed to determine what is acceptable in the long term.
“Whilst general hand-washing and avoiding others suffering with an upper respiratory tract infection (URTI) should definitely be encouraged, we need to work further to understand the impact on wellbeing, isolation and actually managing activities of daily living [from] ‘avoiding social contact’ during winter months,” she said.
“I suspect each person will have differing levels of acceptability for many of these measures and we as healthcare professionals have a role to play in looking at feasibility and informing our patient groups”.
There are several other key additions to this year’s report, including an update to the vaccinations recommended for COPD patients, which now include COVID-19, Tdap and Zoster, and that increased risk of COPD is linked with exposure to high doses of pesticides and ambient levels of particulate matter.
Another significant update is the recognition of fatigue as a symptom of COPD. “It is important to recognise that fatigue is a troubling symptom for many people with COPD and can markedly affect quality of life,” Prof Bolton told the limbic. “This symptom has drawn a lot of recognition in patients recovering from COVID-19 but deserves attention here – as many have suffered with it for many years as part of their COPD.”
According to the guideline, fatigue in people with COPD can be improved through pulmonary rehabilitation, nutritional support, mind-body interventions, and education on how to best self-manage this symptom.
With regard to treatment, new evidence that pharmacotherapy can reduce the rate of lung function decline has been included in the report, as well as findings from the Ethos trial, which showed that the higher (but not lower) dose of ICS was associated with reduced mortality compared to LABA/LAMA therapy.
The report also includes for the first time a section on tele-rehabilitation. Referencing a recent Cochrane review (which included evidence-based models from before the pandemic), the authors state that “the reported results suggest that tele-rehabilitation is safe and has similar benefits to those of centre-based pulmonary rehabilitation across a range of outcomes”.
However, it was also emphasised that the evidence base is “still evolving” and “best practices are not yet established”.
Read the report in full here