#7 COPD Guidelines Update - Saving Lives One Eosinophil at a Time

Are you checking eosinophil counts on your COPD patients?  If not, it's time to start!  Do you know which class of COPD medications have demonstrated a mortality benefit in RCTs?  If not, you don't want to miss this one!

In the premiere episode of Season Two, Bobby and Sandy review updates from the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.   We'll talk about some of the major changes, including the new and improved initial therapy diagram.  We delve into key learnings from the IMPACT and ETHOS trials, and discuss why the LABA+ICS regimens recommended in previous guidelines are now discouraged.

Episode Outline:

• Introduction - 01:35 
• The new and improved 2x2 therapy initiation table - 03:40
• Recommended initial treatment - 05:58
• Use of eosinophils to guide therapy - 09:12
• Factors to consider when adding ICS - 16:33
• Adjusting therapy in follow up - 18:20
• Studies showing mortality benefit with triple therapy - 22:05
• Potential downsides of triple therapy - 25:56
• Wrap up/key takeaways - 28:23

Key Takeaways:

• LABA+ICS is out, triple therapy is in!  In patients with frequent COPD exacerbations, consider triple therapy (especially if they have eosinophils>300) but beware if history of repeated pneumonia, history of mycobacterial infection, or eos <100.  
• Triple therapy is the only pharmacological intervention for COPD with an associated mortality benefit
• ABCD is gone, it’s now ABE.  Be sure that you are doing a formal symptom assessment like the mMRC or CAT!
• More patients are getting LAMA/LABA combination at start than previous guidelines.  Now for all group B and E patients

Episode Links:

• 2023 GOLD Pocket Guide https://goldcopd.org/wp-content/uploads/2023/03/POCKET-GUIDE-GOLD-2023-ver-1.2-17Feb2023_WMV.pdf
• IMPACT Trial (2018)  https://pubmed.ncbi.nlm.nih.gov/29668352/
• ETHOS Trial (2020) https://pubmed.ncbi.nlm.nih.gov/32579807/

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Comments/Questions/Suggestions? Email us at whatstheproofpodcast@gmail.com or find us on Twitter @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay