Chronic obstructive pulmonary disease (COPD) is defined as a "common preventable and treatable disease, characterized by airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in patients." This definition comes from the 2019 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. While there was no update to the GOLD Pocket Guide last year, the app received an update in 2019.
COPD remains the third leading cause of death and few interventions decrease mortality for chronic COPD. Smoking remains the most common cause of COPD and remains relevant despite the recent decrease in tobacco use in the U.S. (amid an explosion of e-cigarette use, especially among teenagers).
To make a formal diagnosis of COPD, providers must perform spirometry. A post-bronchodilator FEV1/FVC <70% is consistent with a diagnosis of COPD. Spirometry classifications are then broken down by the patient's FEV1. The 2019 GOLD guidelines recommend "grading" a patient via the revised ABCD assessment. Non-pharmacologic and pharmacologic treatment is then based on the revised ABCD assessment grade.
The drug market has exploded with new treatments for COPD over the past 5 years. Physicians are inundated with inhaler acronyms: SABA, SAMA, LAMA, LABA, ICS, and combinations of the above. The problem with most guidelines like this is the lack of tools to help providers accomplish these tasks at the point of care during a busy clinic. How are physicians to know which medications should be utilized and in what sequence? The new GOLD guidelines have been released with a companion app of the GOLD Pocket Guide that aims to make this process easy to complete.
Previously on iMedicalApps, we favorably reviewed the COPD Pocket Consultant app by GlaxoSmithKline. Despite its Big Pharma backing, the app was the only one available that included a number of COPD symptom questionnaires such as the COPD Assessment Test (CAT). The other commonly used symptom questionnaire, the modified Medical Research Council (mMRC) scale can be found on the medical calculator app, MedCalX. The prior "official" GOLD app was last updated in 2017.
The 2019 GOLD Pocket Guide app brings the GOLD guideline PDF to life on mobile devices. It is the only COPD app you likely will need. The revised ABCD patient assessment tool allows providers to properly classify and treat patients at the point of care without paging through a long PDF. The caveat is that the evidence of efficacy for many COPD medications is weak when it comes to true patient-oriented outcomes and the GOLD guidelines contain a significant amount of expert opinion and pharmaceutical company ties.
- Only app containing the current 2019 GOLD guidelines for COPD
- Includes revised ABCD assessment, CAT, mMRC scale, and treatment selector calculators
- Available for Android
- Doesn't include evidence rating for recommendations
- Lots of wasted space and some viewing issues (at least on my devices)
- App not as intuitively designed as it could be
This post originally appeared on iMedicalApps.com. by Douglas Maurer DO, MPH, FAAFP July 19, 2019