COPD 2024: Applying the Canadian Thoracic Society (CTS) 2023 Chronic Obstructive Pulmonary Disease (COPD) Guideline for Preventing Exacerbations, Improving Health Status, and Preventing Mortality
DOI:
https://doi.org/10.58931/cpct.2024.2230Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a common, chronic respiratory condition that is associated with the risk of morbidity and mortality. Approximately 2 million Canadians live with COPD, and as many as 1 million suffer while remaining undiagnosed and untreated. COPD exacerbations represent the most expensive cause of hospitalization with the highest likelihood of hospital readmission.
Exacerbations are the primary driver of mortality in patients with COPD. These exacerbations are the second leading cause of hospitalization in Canada with an average length of stay of 7 days. In fact, 1 in 5 patients with COPD will die within 1 year of their first hospitalization due to an exacerbation. For those 65 or older in Ontario, the overall 365-day mortality stands at nearly 28% following their first hospitalization due to an exacerbation. The best indicator of the risk of future exacerbations is a history of exacerbations.
The time has come to end the stepwise pharmacologic escalation that has defined the treatment paradigm in COPD. The call to action is to shift from the slow promotion of inhaled pharmacotherapy based on exacerbations to a direct escalation to inhaled pharmacotherapy with demonstrated evidence to prevent the exacerbations.
References
The Lung Health Foundation. Helping the Missing Million [Internet]. Toronto, ON, Canada: The Lung Health Foundation; 2022 [updated March 2022; cited 26 June 2024]. Available from: https://operationfresh.wpenginepowered.com/wp-content/uploads/2022/03/2022-PRINT-Missing-Million-Report.pdf.
Canadian Institute for Health Information. Hospital Stays in Canada 2021-2022 [Inernet]. 2023 [updated 23 February 2023, cited 26 June 2024]. Available from: https://www.cihi.ca/en/hospital-stays-in-canada-2021-2022.
Ho TW, Tsai YJ, Ruan SY, Huang CT, Lai F, Yu CJ. In-hospital and one-year mortality and their predictors in patients hospitalized for first-ever chronic obstructive pulmonary disease exacerbations: a nationwide population-based study. PLoS One. 2014;9(12):e114866. doi:10.1371/journal.pone.0114866 DOI: https://doi.org/10.1371/journal.pone.0114866
Nie JX, Wang L, Upshur RE. Mortality of elderly patients in Ontario after hospital admission for chronic obstructive pulmonary disease. Can Respir J. 2007;14(8):485-489. doi:10.1155/2007/425248 DOI: https://doi.org/10.1155/2007/425248
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Managment, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Gold Report) [Internet]. Global Initiative for Chronic Obstructive Lung Disease, Inc.; 2024 [cited 26 June 2024] Available from: https://goldcopd.org/wp-content/uploads/2024/02/GOLD-2024_v1.2-11Jan24_WMV.pdf.
O'Donnell DE, Hernandez P, Kaplan A, Aaron S, Bourbeau J, Marciniuk D, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2008 update - highlights for primary care. Can Respir J. 2008;15 Suppl A(Suppl A):1a-8a. doi:10.1155/2008/641965 DOI: https://doi.org/10.1155/2008/641965
Robitaille C, Dajczman E, Hirsch AM, Small D, Ernst P, Porubska D, et al. Implementation of a targeted screening program to detect airflow obstruction suggestive of chronic obstructive pulmonary disease within a presurgical screening clinic. Can Respir J. 2015;22(4):209-214. doi:10.1155/2015/306720 DOI: https://doi.org/10.1155/2015/306720
Bourbeau J, Bhutani M, Hernandez P, Aaron SD, Beauchesne M-F, B. Kermelly S, et al. 2023 Canadian Thoracic Society Guideline on Pharmacotherapy in Patients with Stable COPD. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine. 2023;7(4):173-191. doi:10.1080/24745332.2023.2231451 DOI: https://doi.org/10.1080/24745332.2023.2231451
Zhou Y, Zhong NS, Li X, Chen S, Zheng J, Zhao D, et al. Tiotropium in early-stage chronic obstructive pulmonary disease. N Engl J Med. 2017;377(10):923-935. doi:10.1056/NEJMoa1700228 DOI: https://doi.org/10.1056/NEJMoa1700228
Bednarek M, Maciejewski J, Wozniak M, Kuca P, Zielinski J. Prevalence, severity and underdiagnosis of COPD in the primary care setting. Thorax. 2008;63(5):402-407. doi:10.1136/thx.2007.085456 DOI: https://doi.org/10.1136/thx.2007.085456
Haughney J, Gruffydd-Jones K, Roberts J, Lee AJ, Hardwell A, McGarvey L. The distribution of COPD in UK general practice using the new GOLD classification. Eur Respir J. 2014;43(4):993-1002. doi:10.1183/09031936.00065013 DOI: https://doi.org/10.1183/09031936.00065013
Hurst JR, Vestbo J, Anzueto A, Locantore N, Müllerova H, Tal-Singer R, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128-1138. doi:10.1056/NEJMoa0909883 DOI: https://doi.org/10.1056/NEJMoa0909883
Punekar YS, Mullerova H, Small M, Holbrook T, Wood R, Naya I, et al. Prevalence and burden of dyspnoea among patients with chronic obstructive pulmonary disease in five European countries. Pulmonary Therapy. 2016;2(1):59-72. doi:10.1007/s41030-016-0011-5 DOI: https://doi.org/10.1007/s41030-016-0011-5
Bourbeau, J., Bhutani, M., Hernandez, P., Aaron, S. D., Balter, M., Beauchesne, M. F., … Marciniuk, D. D. (2019). Canadian Thoracic Society Clinical Practice Guideline on pharmacotherapy in patients with COPD – 2019 update of evidence. Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 3(4), 210–232. https://doi.org/10.1080/24745332.2019.1668652 DOI: https://doi.org/10.1080/24745332.2019.1668652
Ferguson GT, Rabe KF, Martinez FJ, Fabbri LM, Wang C, Ichinose M, et al. Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial. Lancet Respir Med. 2018;6(10):747-758. doi:10.1016/s2213-2600(18)30327-8 DOI: https://doi.org/10.1016/S2213-2600(18)30327-8
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Canadian Primary Care Today
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
