You have a 58 yo male patient who is evaluated because of worsening dyspnea, chronic productive cough, and increasing sputum production.
He has a 30 pack-year smoking history. Spirometry shows a FEV1/FVC ratio <0.7. FEV1 is 60% of predicted. He enjoys daily walks with his neighbors, but has to walk slower than others because of breathlessness. He occasionally has to stop for breath when walking at his own pace. He has not been hospitalized for COPD exacerbations during the past 1 year.
1) What is the most appropriate classification of the severity of this patient’s airflow limitation?
2) What is this patient’s degree of breathlessness based on the modified Medical Research Council Dyspnea Scale (mMRC)?
3) Based on the combined assessment of airflow limitation, level of symptoms, and exacerbation risk, in which GOLD patient group does this patient belong?
4) What medications are indicated for initial treatment? What are alternative regimens? What nonpharmacologic treatments are recommended?
Refer to GOLD AJRCCM 2013
Based on FEV1 of 60%, patient is in GOLD class II; his mMRC score is 2 and has no exacerbation. This will make patient low risk more symptomatic. Therapy includes Long acting bronchodilators ( long acting anticholinergic or beta agonist). Alternative therapy includes short acting bronchodilators. Pulmonary rehab and smoking cessation (if current smoker) are non-pharmacological interventions.
Now if this patient is indeed a Group B, what would people do if the patient came to you on Advair and Spiriva, which they often do? Would you de-escalate back to Spiriva for example?
Reviewed with Kamelia in CC and she got the answers right!