GOLD Report | About COPD

GOLD Report for COPD

GOLD recommends prescribing a long-acting bronchodilator for maintenance treatment, with a goal to manage symptoms

  • GOLD recommends using long-acting bronchodilators, including long-acting muscarinic antagonists (LAMAs), as a standard of care for COPD maintenance therapy1
  • Use of short-acting bronchodilators for maintenance treatment is generally not recomended
  • >2/3 of COPD patients in clinical practice make at least 1 error using an inhalation device1

GOLD does not endorse any specific treatments. Refer to the GOLD 2019 Report for complete recommendations.

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was launched in 1997 in collaboration with the National Heart, Lung, and Blood Institute, the National Institutes of Health, USA, and the World Health Organization. The GOLD Report is shaped by committees made up of leading experts from around the world. Working with health care professionals and public health officials, GOLD seeks to raise awareness and improve prevention and treatment of COPD.


Assess COPD symptoms, exacerbation risk, and patient response to determine initial and follow-up pharmacological treatment

Initial Pharmacological Treatment

GOLD Initial Pharmacological Treatment

Follow-up Pharmacological Treatment

1. IF RESPONSE TO INITIAL TREATMENT IS APPROPRIATE, MAINTAIN IT

2. IF NOT:

  Consider the predominant treatable trait to target (dyspnea or exacerbations)

  Use exacerbation pathway if both exacerbations and dyspnea need to be targeted

  Place patient in box corresponding to current treatment and follow indications

  Assess response, adjust, and review

  These recommendations do not depend on the ABCD assessment at diagnosis

GOLD Follow-up Pharmacological Treatment

Consider de-escalation of ICS or switch if pneumonia, inappropriate original indication, or lack of response to ICS.
§ Consider if eos ≥300 or eos ≥100 AND ≥2 moderate exacerbations/1 hospitalization.

GOLD does not endorse any specific treatments. Refer to the GOLD 2019 Report for complete recommendations.

LAMA=long-acting muscarinic antagonist; LABA=long-acting beta2-adrenergic agonist; ICS=inhaled corticosteroid; eos=blood eosinophil count in cells per microliter; mMRC=modified British Medical Research Council Questionnaire; CAT™=COPD Assessment Test™.

© 2019 Global Strategy for Diagnosis, Management, and Prevention of COPD. All rights reserved. Use is by express license from the owner.

 

Following implementation of therapy, reassess patients for attainment of treatment goals

GOLD recommends reviewing symptoms, assessing inhalation device technique, and then adjusting pharmacological treatment as needed.1

Management Cycle

GOLD Management Cycle

*Response to escalation should always be reviewed. De-escalation should be considered if there is a lack of clinical benefit and/or side effects.
Including pulmonary rehabilitation and self-management education.

GOLD does not endorse any specific treatments. Refer to the GOLD 2019 Report for complete recommendations.

© 2019 Global Strategy for Diagnosis, Management, and Prevention of COPD. All rights reserved. Use is by express license from the owner.


Reference:
1. Global strategy for the diagnosis, management and prevention of COPD: 2019 report. Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2019:1-139.

Important Safety Information & Indication

Important Safety Information
 

LONHALA MAGNAIR is contraindicated in patients with a hypersensitivity to glycopyrrolate or to any of the ingredients.

LONHALA MAGNAIR should not be initiated in patients with acutely deteriorating or potentially life-threatening episodes of COPD or used as rescue therapy for acute episodes of bronchospasm. Acute symptoms should be treated with an inhaled short-acting beta2-agonist.

As with other inhaled medicines, LONHALA MAGNAIR can produce paradoxical bronchospasm that may be life-threatening. If paradoxical bronchospasm occurs following dosing with LONHALA MAGNAIR, it should be treated immediately with an inhaled, short-acting bronchodilator; LONHALA MAGNAIR should be discontinued immediately and alternative therapy instituted.

Immediate hypersensitivity reactions have been reported with LONHALA MAGNAIR. If signs occur, discontinue LONHALA MAGNAIR immediately and institute alternative therapy.

LONHALA MAGNAIR should be used with caution in patients with narrow-angle glaucoma and in patients with urinary retention. Prescribers and patients should be alert for signs and symptoms of acute narrow-angle glaucoma (e.g., eye pain or discomfort, blurred vision, visual halos or colored images in association with red eyes from conjunctival congestion and corneal edema) and of urinary retention (e.g., difficulty passing urine, painful urination), especially in patients with prostatic hyperplasia or bladder-neck obstruction. Patients should be instructed to consult a physician immediately should any of these signs or symptoms develop.

The most common adverse events reported in ≥2% of patients taking LONHALA MAGNAIR, and occurring more frequently than in patients taking placebo, were dyspnea (4.9% vs 3.0%) and urinary tract infection (2.1% vs 1.4%).

LONHALA solution is for oral inhalation only and should not be injected or swallowed. LONHALA vials should only be administered with MAGNAIR.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

For additional information, please see full Prescribing Information and Patient Information for LONHALA MAGNAIR at www.sunovionprofile.com/lonhala-magnair.

Indication
 

LONHALA® MAGNAIR® (glycopyrrolate) is an anticholinergic indicated for the long-term maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.