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ABCDABCD mMRC < 2 CAT <10 mMRC >2 CAT > >2>2 RISK GOLD RISK Exacerbation TypeCharatteristicSpirometric classification Exacerbation Per year CAT A Low risk, low symptomsGOLD1 / GOLD2< 1< 10 B Low risk, high symptomsGOLD1 / GOLD2< 1> 10 C High risk, low symptomsGOLD3 / GOLD4+2< 10 D High risk, High symptomsGOLD3 / GOLD4+2> 10 Downloaded from © Progetto LIBRAwww.goldcopd.it
TypeFirst choiceSecond choiceAlternative choice A SABA or SAMA prnSABA and SAMA LABA or LAMA Theophylline B LABA or LAMALABA and LAMATheophylline SABA and/or SAMA C ICS/LABA or LAMALABA and LAMA ICS and LAMA Theophylline SABA and/or SAMA Consider PDE4-inh* D ICS/LABA or LAMAICS/LABA and LAMA ICS/LABA and PDE4-inh* LAMA and PDE4-inh Theophylline SABA and/or SAMA Carbocysteine ABCDABCD mMRC < 2 CAT <10 mMRC >2 CAT > >2>2 RISK GOLD RISK Exacerbation Downloaded from - © Progetto LIBRAwww.goldcopd.it
Downloaded from - © Progetto LIBRAwww.goldcopd.it
Figure 2.3: RISK IN COPD: Placebo-limb data from TORCH 143*, Uplift 142† and Eclipse 131≠ GOLD spirometric level Exacerbations (per year) *†≠ Hospitalizations (per year) * ≠ 3-year Mortality *† GOLD 1: Mild? ? ? GOLD 2: Moderate % *† GOLD 3: Severe % * GOLD 4: Very severe1.2 – % * Downloaded from - © Progetto LIBRAwww.goldcopd.it
Table 2.3: Modified Medical Research Council Questionnaire for Assessing the Severity of Breathlessness PLEASE TICK IN THE BOX THAT APPLIES TO YOU (ONE BOX ONLY) mMRC Grade 0. I only get breathless with strenuous exercise. mMRC Grade 1. I get short of breath when hurrying on the level or walking up a slight hill. mMRC Grade 2. I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breath when walking on my own pace on the level. mMRC Grade 3. I stop for breath after walking about 100 meters or after a few minutes on the level. mMRC Grade 4. I am too breathless to leave the house or I am breathless when dressing or undressing. Downloaded from - © Progetto LIBRAwww.goldcopd.i
© Global Initiative for Chronic Obstructive Lung Disease GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD): TEACHING SLIDE SET December 2011.
© Global Initiative for Chronic Obstructive Lung Disease GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD): TEACHING SLIDE SET January 2013.
Nottinghamshire COPD and Asthma Guidelines Dr Esther Gladman GP Prescribing Lead, Medicines Management Nottingham City CCG Feb 2012.
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