As Good as GOLD with Dr. Antonio Anzueto

Antonio Anzueto is Professor of Medicine at the University of Texas Health Science Center and Chief of the Pulmonary Section for the South Texas Veterans Health Care System, San Antonio, Texas, USA. He is a member of a number of medical committees, a reviewer for various scientific journals including the New England Journal of Medicine, and has published over 200 manuscripts in highly rated medical journals. He has extensive research experience as has been the principal investigator of numerous large multicenter clinical trials and helped develop the new 2017 GOLD (Global Initiative for COPD) guidelines. He is on the science committee for the GOLD organization.

Recently GOLD guidelines were changed - can you talk about changing severity of COPD based on airflow limitation to now severity and symptoms? Was it a good move?

• We still look at severity, we just now have treatment geared towards symptoms

• Tailor treatment to patients, not numbers

What is the phenotype of the frequent COPD exacerbator?

• We have no biomarker as of yet to indicate this

• Typically means they have >1 exacerbation a year

• Think: are they taking their meds? Do they have another uncontrolled co-morbidity?

• Primarily GOLD group D

• Pharmacotherapy has gone so far. People with COPD are living longer; and their SOB actually may be from something else

What would make you decide to add an ICS and what would make you take it away?

• "What to do next" algorithm coming soon

• Patients with history of asthma, >2 exacerbation or high eosinophils (>300)