👀it’s out! The llatest 2023 @GOLD_COPD guidance has been released...
🌟There are BIG changes this year. Here are my first thoughts… but lots to digest:
TL/DR: 1. Revised #COPD defn 2. Etiotypes 3. ABCD is out, ABE is in 4. Farewell ICS-LABA 5. New exacerbation defn
1/n👇
1. Definition of COPD now *includes* emphysema…
'heterogeneous lung condition characterized by chronic respiratory symptoms due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction’
Etiotypes??👀👇
An alphabet soup from COPD-A (asthma), through 'C (cigarette smoking), 'D (abnormal lung development) and 'G (genetic #alpha-1), to 'I (infections), 'P (pollution) and U (unknown).
What do you make of this? A similar approach has helped in pulmonary hypertension!
3. ABCD moves to ABE. 👀👇
4. Farewell ICS-LABA –well this hasn't made sense for a while given backbone dual bronchodilator is so effective. If you needed ICS, why wouldn't you put the LAMA in too?
The challenge here will be the widespread use of ICS-LABA, and many settings don’t have access to Triple.
5. The new exacerbation definition is aligned with that in the ‘Rome’ proposal… but this still needs prospective validation.
How do you know if someone is on an expected trajectory post hospital discharge?
Here is a first look at our needs assessment and service evaluation, from a collaboration across @RoyalFreeNHS and @uclh.
We wanted to help others doing similar work 1/n:
WHAT WE DID.
Mostly 📞 follow-up of people who had COVID-19 (swab+), aiming for 4-6 weeks after discharge. Phone script delivered by an amazing group of @UCLMS medical students and doctors in training. People with abnormal bloods or imaging on discharge invited to repeat them.
WHAT WE FOUND:
This is 384 people followed a median of 54 (47-59) days from discharge.
69% had fatigue.
53% had breathlessness.
34% had cough.
14% experienced symptoms of depression.