Summarizing the 2021 Updated GOLD Guideline for COPD

Mackenzie Laisure, PharmD Candidate 2022; Nicole Covill, PharmD Candidate 2022; Marissa L. Ostroff, PharmD, BCPS, BCGP; Jared L. Ostroff, PharmD, MBA, BCACP, BCGP


US Pharmacist. 2021;46(7):30-36. 

In This Article

COPD Exacerbations

Exacerbations may be triggered by several factors, most commonly infections of the respiratory tract. Conditions with nonspecific symptoms similar to a COPD exacerbation include pneumonia, pneumothorax, pleural effusion, pulmonary embolism, pulmonary edema, and/or cardiac arrhythmias. The goal of therapy when treating a COPD exacerbation is to minimize the negative impact of the current exacerbation and prevent future events. The recommended initial treatment for mild exacerbations is the use of short-acting beta2-agonists (SABA), with or without short-acting anticholinergics. In moderate-to-severe exacerbations, in addition to the SABA, systemic corticosteroids and antibiotics may also be used for no more than 5 to 7 days to improve FEV1, shorten recovery time, reduce the risk of early relapse, and shorten duration of hospitalization. The guidelines recommend continuing the use of long-acting bronchodilators throughout the exacerbation or to start these medications as soon as possible before discharge.

Infection with the SARS-CoV-2 virus may put a patient with COPD at increased risk of complications, including exacerbation and hospitalization. One systematic review and meta-analysis looked at the prevalence, severity, and mortality associated with COPD and smoking in patients with COVID-19. This analysis looked at 15 different studies and a total of 2,473 confirmed COVID-19 patients. While only 2% of the patients also had COPD, they concluded that patients with COPD, without differentiation of COPD severity, were at a higher risk of COVID-19 severity (63%) and mortality compared with patients without (33.4%).[10] While patients with COPD may not be at an increased risk of infection, they may be at an increased risk of complications and hospitalization due to infection.

If a patient with COPD contracts the SARS-CoV-2 virus, there is no evidence that COPD medications should be altered, and treatment should be the same standard of care that other COVID-19 patients receive. As this is a respiratory virus, it may trigger and aggravate COPD exacerbation. Post COVID-19 infection, all patients with COPD should undergo rehabilitation and follow-up.