GOLD 2017
Zinc-nummer: NOR/RESP/0022/17 Mai 2017
Thomas Jrgens Lill Lena Nyberg Medisinsk avdeling, GSK Norge
Diagnostisering og vurdering av kolspasienter
Reference: Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2011. 4
Vurdering av luftstrms-
obstruksjonens alvorlighet
Spirometri
GOLD 2011
Vurdering av luftveissymptomer
Vurdering av risiko for eksaserbasjoner
Anamnese
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2017. Available from: http://goldcopd.org. Accessed March 2017.
CAT
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2017. Available from: http://goldcopd.org. Accessed March 2017.
Eksa
serb
asjo
nshi
stor
ik
2 (or 1 som frte til
sykehusinlegelse)
0 or 1 ikke
sykehusinlegelse
CAT
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2017. Available from: http://goldcopd.org. Accessed March 2017.
Eksa
serb
asjo
nshi
stor
ik
2 (or 1 som frte til
sykehusinlegelse)
0 or 1 ikke
sykehusinlegelse
CAT
8
GOLD 2017 COPD Assesment Test
Oversikt over behandlingsalternativer
GOLD 2017: Behandlingsalternativer Inhalasjonsmedisin
10
LABA Langtidsvirkende beta-2-agonist LAMA Langtidsvirkende muskarin- antagonist ICS Inhalasjonskortikosteroid (Skal ikke brukes i monoterapi ved kols)
Kombinasjoner: ICS/LABA LAMA/LABA Trippelbehandling (LAMA+ICS+LABA)
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner.
GOLD 2017: Behandlingsalternativer Inhalasjonsmedisin
11
Pasient-respons, preferanse og korrekt bruk av inhalator Ca 2/3 av pasientene gjr minst en feil ved bruk av inhalatoren sin De viktigste risikofaktorene for feil:
Hy alder Bruk av flere typer inhalatorer Mangel p opplring i korrekt bruk
Feil bruk av inhalator frer til drligere symptomkontroll Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all
rights reserved. Use is by express license from the owner.
12 A Korttids- eller langtids-virkende bronkodilator
evaluer effekt
Fortsett, stopp eller prv en annen klasse av bronkodilator
Ytterligere eksaserbasjoner
LAMA/ LABA
ICS/ LABA
LAMA
D
LAMA/LABA ICS/
LABA LAMA
LAMA/LABA/ICS
Vurder makrolider
Vurder roflumilast dersom FEV1
Pasienter i GOLD B
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2017. Available from: http://goldcopd.org. Accessed March 2017.
Eksa
serb
asjo
nshi
stor
ik
2 (or 1 som frte til
sykehusinlegelse)
0 or 1 ikke
sykehusinlegelse
CAT
FEV1, forced expiratory volume in 1 second; CAT: COPD Assessment Test
15
Mann, 65 r Ryker (30 pakker) FEV1: 58% av forventet normalverdi CAT-skre 15 Ingen exacerbasjoner Forblir tungpustet selv om han bruker
korttidsvirkende bronkodilator
En typisk pasientprofil i GOLD B
GOLD 2017 Behandling av GOLD B
16 1. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner. 2. Dransfield MT et al. Prim Care Respir J. 2011;20:46-53
LAMA
LABA
Flere enn 50% pasientene plages fortsatt med moderat til svrt alvorlig tungpust selv om de str
p en enkel bronkodilator2
LABA/LAMA vs. LAMA eller LABA alene
17
Resultater fra en integrert meta-analyse av 23 randomiserte, kontrollerte studier (n=27 172)
Ref: Oba Y et al. Thorax. 2016;71:1525.
Sikkerhetsprofilen til kombinasjonen
LAMA/LABA er lik som LAMA eller LABA alene
Reduserer tungpust (TDI)
Bedrer lungefunksjon (FEV1)
Bedrer livskvalitet (SGRQ)
18 Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner.
LAMA
LABA
LAMA/LABA
GOLD 2017 Behandling av GOLD B
Pasienter i GOLD D
GOLD. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2017. Available from: http://goldcopd.org. Accessed March 2017.
Eksa
serb
asjo
nshi
stor
ik
2 (or 1 som frte til
sykehusinlegelse)
0 or 1 ikke
sykehusinlegelse
CAT
Eksaserbasjoner Konsekvenser for pasienten
21
~50 % av kolspasientene som legges inn pga. eksaserbasjon, dr innen 5 r4
Det kan ta opp til 6 mneder for en pasient komme seg etter en akutt eksaserbasjon2,3
Hver eneste eksaserbasjon man klarer forhindre, betyr noe for pasienten!
1. Barnes N, et al. BMC Pulm Med 2013;13:54. 2. Spencer S, Jones PW. Thorax. 2003;58:589593. 3. Jones PW et al. Journal of Obstructive Pulmonary Disease 2005; 2: 75-79. 4. Garcia-Aymerich J et al. Thorax 2011;66:58590.
22
D
LAMA/LABA ICS/
LABA LAMA
LAMA/LABA/ICS
Vedvarende symptomer/ytterligere
eksaserbasjoner
Ytterligere eksaserbasjoner
Foretrukket behandling =
GOLD 2017 Behandling av stabil kols Anbefalt behandling av pasienter i GOLD D (inhalasjonsmedisin)
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner.
23
D
LAMA/LABA ICS/
LABA LAMA
LAMA/LABA/ICS
Vedvarende symptomer/ytterligere
eksaserbasjoner
Ytterligere eksaserbasjoner
Foretrukket behandling =
GOLD: Mangel p direkte bevis som sttter behandlings-
anbefalingene for pasienter i GOLD C og D
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner.
GOLD 2017 Behandling av stabil kols Anbefalt behandling av pasienter i GOLD D (inhalasjonsmedisin)
En typisk pasientprofil i GOLD D
24
Kvinne, 69 r Har rlige eksaserbasjoner som krever
behandling FEV1 48% av forventet normalverdi CAT-skre 21 Str p ICS/LABA og hyppig bruk av
SABA
COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; CAT, COPD Assessment Test
25
D
LAMA/LABA ICS/
LABA LAMA
Ytterligere eksaserbasjoner
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner.
Foretrukket behandling =
GOLD 2017 Behandling GOLD D
26
D
LAMA/LABA ICS/
LABA LAMA
Ytterligere eksaserbasjoner
1. Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner 2. Nannini LJ, Poole P, Milan SJ et al. Combined corticosteroid and long-acting B-agonist in one inhaler vs placebo for COPD (Review). Cochrane. 2013 3. Nannini lJ, Lasserson TJ, Poole P Combined corticosteroid and long-acting B-agonist in one inhaler vs LABA for COPD (Review). Cochrane 2012
2 Cochrane-rapporter2,3: ~25% reduksjon i risiko for eksaserbasjoner med:
Salmeterol/flutikasonpropionat Formeterol/Budesonid
Foretrukket behandling =
GOLD 2017 Behandling GOLD D
27
D
LAMA/LABA ICS/
LABA LAMA
Ytterligere eksaserbasjoner
GOLD 2017 Behandling GOLD D
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner 2. Cooper CB, Anzueto A., Decramer M, et al Int J Chron Obstruct Pulmon Dis 2011; 6: 269-752.
~17% reduksjon i risiko for eksaserbasjon for
tiotropium (10 studier, 12 163
pasienter)2
Foretrukket behandling =
D
LAMA/LABA ICS/
LABA LAMA
Ytterligere eksaserbasjoner
Foretrukket behandling =
Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Pulmonary Disease (GOLD) 2017. 2017 Global Initiative for Chronic Obstructive Lung Disease, all rights reserved. Use is by express license from the owner.
FLAME-studien
GOLD 2017 Behandling GOLD D
FLAME-studien: indakaterol/glykopyrronium vs.
