Hyperinflation, COPD screening, smoking cessation among changes in 2024 GOLD report

Key takeaways:

• The 2024 GOLD report newly highlights hyperinflation, COPD screening and smoking cessation pharmacotherapies.
• Several sections have also been revised or expanded.

To reflect advances in COPD diagnosis and treatment, the 2024 Global Initiative for Chronic Obstructive Lung Disease report features both new and revised sections.

“The changes that were introduced in the document are not all based on very recent evidence, but we thought that the areas, the topics, are underrepresented, that they need more attention, and therefore we ... revised them,” Claus F. Vogelmeier, MD, chair of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) science committee and professor at Philipps University of Marburg, said at the 2023 GOLD COPD conference.

Last year, Healio reported on key changes in the 2023 GOLD COPD report.

New sections

The 2024 report contains three new sections on hyperinflation, COPD screening in targeted populations and pharmacotherapies for smoking cessation.

Notably, this report did not change the algorithms for assessment and treatment, Vogelmeier said.

In terms of hyperinflation, Vogelmeier said it is currently “underrated” and “underestimated.” During his presentation, he highlighted studies from the early 2000s that have shown that it negatively impacts inspiratory capacity and heightens all-cause and respiratory-related mortality in patients with COPD.

“Right now, we do not really know how to address hyperinflation beyond doing invasive procedures when patients are at a very advanced stage of their disease, but altogether we think this is a very important topic,” Vogelmeier said.

Within the section of screening for COPD in targeted populations, authors of the report noted that further analysis of low-dose CT scans involved in lung cancer screening and spirometry of these individuals allows for screening of COPD symptoms and airflow obstruction.

Vogelmeier highlighted one study by Mamta Ruparel, MBBS, BSc, MRCP, PhD, academic clinical lecturer at University College London’s Lungs for Living Research Centre, and colleagues — previously covered by Healio — that looked at these measures in a lung cancer screening cohort. Researchers found that 67% (n = 377) of the total cohort had undiagnosed COPD. Further, of the undiagnosed individuals with a low-dose CT scan (n = 297), 68% had emphysema.

When researchers looked at reported respiratory symptoms of those with no COPD, undiagnosed COPD and known COPD within the last year, they observed a lower prevalence of persistent cough, dyspnea and lower respiratory tract infections among those with undiagnosed COPD vs. those with known COPD.

These findings are important considering the known consequences of undiagnosed COPD, Vogelmeier said.

“We have seen data from Denmark that clearly suggest that undiagnosed COPD causes a lot of problems ... these patients go to hospital, they develop exacerbations,” he said.

The last new section delves into pharmacotherapies for smoking cessation, and Vogelmeier exclusively discussed the report’s stance on vaping/e-cigarettes as a cessation tool.

During the conference, he shared a study by Wubin Xie, DrPH, MPH, postdoctoral associate in the department of global health at Boston University School of Public Health, and colleagues. As Healio previously reported, this study found that e-cigarette use was associated with increased risk for developing major respiratory diseases, including asthma, bronchitis and COPD, independent of cigarette smoking or use of other tobacco products.

“With this as a background, we say in the document that based on the available evidence, and the lack of knowledge about the long-term effects of e-cigarettes on respiratory health, we believe that it's not possible to recommend this intervention for smoking cessation,” Vogelmeier said.

Revised sections

In addition to the various new sections added, several sections have been revised or updated to reflect current evidence on the topic.

The section on spirometry now features clear information on when to conduct post-bronchodilator spirometry based on pre-bronchodilator findings.

According to Vogelmeier, the 2024 report states that COPD is likely if the fixed ratio from pre-bronchodilator spirometry is less than 0.7, and this warrants confirmation with post-bronchodilator spirometry. On the other hand, COPD is not present in individuals if the fixed ratio is greater than 0.7, and clinicians should only do bronchodilator spirometry if they have high suspicion.

Another important update can be found under the imaging section of the report, which now includes interstitial lung abnormalities (ILAs).

Vogelmeier stated that the most important dataset they found that covers this topic was published in American Journal of Respiratory and Critical Care Medicine and conducted by Jonathan A. Rose, MD, pulmonologist at Brigham and Women’s Hospital, and colleagues.

As Healio previously reported, this study found that about half of patients with ILAs had suspected interstitial lung disease, with these patients having greater symptoms and more unfavorable clinical outcomes.

When discussing the new section on pharmacotherapies for smoking cessation, Vogelmeier also noted that revisions have been made to the section on smoking cessation. This section highlights strategies to help patients who want to quit and recommendations for treating tobacco use and dependence.

Vaccination recommendations for patients with COPD have also been updated to reflect the CDC’s recommendation of the new respiratory syncytial vaccine for older adults (> 60 years) and/or those with chronic heart or lung disease.

During his presentation, Vogelmeier pointed out that COPD and asthma are listed on the CDC’s website as conditions linked to a greater risk for severe RSV.

Notably, the 2024 report has also combined two chapters, making for a total of six chapters to improve readability, Vogelmeier said.

“When you develop a document over time, like the GOLD document ... it grows and grows, and it gets very redundant and complicated and longer and difficult to read,” he said during his presentation. “Therefore, we decided that we have to clean it up.”

Expanded sections

Lastly, when discussing key changes in the 2024 report, Vogelmeier highlighted that more information has been added on preserved ratio impaired spirometry (PRISm) and managing inhaled therapies.

A 2021 study in JAMA found that PRISm, represented as an FEV₁/FVC of 0.7 or more plus an FEV₁ less than 80% predicted post-bronchodilator, impacts all-cause mortality.

Further, recent data in International Journal of COPD have shown that “PRISm is not a stable phenomenon,” according to Vogelmeier. During his presentation, he noted that among those initially classified as having PRISm (n = 86) in this study, 53.5% continued to show this type of lung function over 5 to 9 years, whereas 19.8% developed GOLD 1 to 4 COPD and 26.7% reached normal spirometry.

In the section on managing inhaled therapies, Vogelmeier said the report now features information on how clinicians and patients with COPD can lower CO₂ emissions.

According to the report, “The proper use of an inhaler has a positive environmental impact through the reduction of exacerbations and their CO₂ footprint (especially when hospitalization is required).”

In order for this change to take place, the report emphasizes that patients must receive the right inhaler and clinicians must properly educate and train the patient on how to use the device.

References:

• Global initiative for chronic obstructive lung disease 2024 report. https://goldcopd.org/wp-content/uploads/2023/11/GOLD-2024_v1.0-30Oct23_WMV.pdf. Accessed Nov. 14, 2023.
• GOLD report 2024 key changes summary. https://goldcopd.org/wp-content/uploads/2023/11/KEY-CHANGES-GOLD-2024.pdf. Accessed Nov. 14, 2023.
• Perez-Padilla R, et al. Int J Chron Obstruct Pulmon Dis. 2023;doi:10.2147/COPD.S406208.
• Rose JA, et al. Am J Respir Crit Care Med. 2022;doi:10.1164/rccm/202203-0550OC.
• Ruparel M, et al. Ann Am Thorac Soc. 2020;doi:10.1513/AnnalsATS.201911-857OC.
• Wan ES, et al. JAMA. 2021;doi:10.1001/jama.2021.20939.
• Xie W, et al. JAMA Netw Open. 2020;doi:10.1001/jamanetworkopen.2020.20816.