2019 GOLD Guidelines for COPD: Update Quiz

Every year, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) updates its guidelines on the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD). The 2019 GOLD update focused on 3 areas: simplifying treatment, using the ABCD assessment, and using management cycles. Take 5 minutes to answer the 5 questions below to see how much you know about what has changed. 

1. The ABCD assessment tool is recommended for initial treatment of COPD as well as treatment adjustment.

A. True

B. False
 

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Answer: B. False. The updated 2019 GOLD guidelines only recommend the ABCD assessment for determining initial treatment of COPD, and not for subsequent treatment adjustment. The ABCD assessment tool grades COPD symptom burden and risk for exacerbation and spirometric measurement is regarded separately. Treatment adjustment, the guidelines now recommend, should be based on “the patient’s major treatable trait(s) and the currently used drug(s).”

2. Which of the following is/are recommended for the management of COPD after initial therapy?

A. Medical Research Council (mMRC) dyspnea scale

B. COPD Assessment Test (CAT) score

C. Management cycle

D. Both A and B

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Answer: C. Management cycle. The 2019 GOLD guidelines no longer recommend using the mMRC dyspnea scale or the CAT score to manage COPD after initial diagnosis. Instead, the guidelines recommend adjusting treatment using the management cycle, which is a 3-step process based on symptoms and exacerbations rather than a patient’s initial GOLD group at diagnosis.

3. The management cycle includes which of the following step(s)?

A. Assess inhaler technique

B. Assess pulmonary rehabilitation

C. Assess adherence

D. All of the above

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Answer: D. All of the above. The management cycle is individualized and based on the following 3 steps:

• Review symptoms and exacerbations

• Assess inhaler technique, adherence, and nonpharmacologic treatments (eg, pulmonary rehabilitation, self-management, education)

• Adjust medication, including medication escalation or de-escalation, as well as switching inhaler device or medication.

4. Inhaled corticosteroids (ICS) are recommended as initial therapy in which of the following GOLD groups?

A. Group A

B. Group B

C. Group C

D. Group D

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Answer: D. Group D.  In the 2019 GOLD update, inhaled corticosteroids (ICS) are no longer recommended as initial therapy in Group C.* ICS combined with a long-acting ß_²-agonists (LABA) is only recommended as initial therapy in individuals in group D** who have eosinophil count ≥300 cells/µL. In these patients this combination has the greatest likelihood of reducing exacerbations. Eosinophil count is recommended in the 2019 update to guide ICS therapy.

*GOLD Group C: ≥2 moderate exacerbations or ≥1 leading to hospitalization and mMRC 0-1 or CAT <10).

**GOLD Group D: ≥2 moderate exacerbations or ≥1 leading to hospitalization and mMRC ≥2 or CAT ≥10

5. Which of the following is recommended as initial pharmacologic treatment in Group A?

A. Bronchodilator

B. LABA

C. Long-acting muscarinic agent

D. ICS

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Answer: A. Bronchodilator. Bronchodilators, either short- or long-acting, are recommended as initial therapy for Group A in which patients have 0 or 1 moderate exacerbations (not leading to hospitalization) and mMRC 0-1 or CAT score <10.

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Source: Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease 2019 report. Accessed June 13, 2019 at: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS