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  • The Review Course in Family Medicine

GUIDELINE ALERT: NEW FIRST-LINE COPD TREATMENT

PLUS: CCFP Exam Mistake To Avoid

by Dr. Simon Moore MD CCFP FCFP




























In September 2023 the Canadian Thoracic Society published new guidelines for management of COPD. Here are the changes you must know for clinical practice and when studying for the CCFP exam:


WHAT’S NEW?


1. For mild* COPD, start with a LAMA or LABA.


Either long-acting bronchodilator (LABD) - long-acting muscarinic antagonist (LAMA) or long-acting beta-2 agonist (LABA) is OK as both are equivalent. This has changed as the 2019 recommendations suggested start with short-acting bronchodilator (SABD), not LABD.

NOTE: as-needed SABA is still recommended for every COPD patient.

2. For moderate – high* symptom COPD, start a combination LAMA/LABA.


The 2019 recommendations suggested either LAMA or LABA.


AVOID LOSING MARKS ON THE CCFP EXAM


“Bronchodilator” alone could be a wrong answer so specify “long-acting bronchodilator” or “short-acting bronchodilator.” Old SAMP marking guides on the CCFP’s website (find them on our EXAM ESSENTIALS page) show that you can lose marks for incomplete answers. Be specific when writing your answers: ask yourself “is there anything else I can add?”


THE BASICS HAVEN’T CHANGED


· *COPD patients should still be stratified as MILD, MODERATE, or SEVERE

· Mild = mMRC breathlessness scale 1 or COPD Assessment Test (CAT) < 10, FEV1 > 80%.

· Moderate & Severe: CAT ≥ 10, mMRC ≥ 2, FEV1 < 80%

· For low risk of acute exacerbation of COPD (AECOPD), first-line is now LAMA or LABA


To learn more about the rationale for the changes and read the complete guideline and author disclosures, check out the full guideline. Of note, 13 of the 17 authors have received personal payments and grant funding from pharmaceutical companies whose products are recommended in the guideline.


P.S.

With your busy schedule it can be tough to keep up with all the new guidelines. That’s why The Review Course faculty compile these changes for you – every year we conduct a literature review of all 105 Topics for the CCFP Exam.


To get all these updates join us for one of our 2024 events in Montreal, Toronto, Calgary or Vancouver, and because we love to have fun at The Review Course, we're going back to Vegas too! Register today


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