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 New 2017 GOLD Guidelines for COPD Released
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Dave-OH
Administrator

USA
4072 Posts

Posted - Apr 14 2018 :  4:21:37 PM  Show Profile  Reply with Quote
https://pulmccm.org/copd-review/new-2017-gold-guidelines-copd-released/

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muddleaged
Member

USA
53 Posts

Posted - Apr 14 2018 :  5:33:41 PM  Show Profile  Reply with Quote
Here's the full report for 2018:
http://goldcopd.org/wp-content/uploads/2017/11/GOLD-2018-v6.0-FINAL-revised-20-Nov_WMS.pdf
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Dave-OH
Administrator

USA
4072 Posts

Posted - Apr 14 2018 :  8:49:00 PM  Show Profile  Reply with Quote
My post has easy to read info, the whole report is 142 pages.

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fatpuppy
Member

174 Posts

Posted - Apr 15 2018 :  09:06:20 AM  Show Profile  Reply with Quote
quote:
Originally posted by Dave-OH

https://pulmccm.org/copd-review/new-2017-gold-guidelines-copd-released/



The paragraph I found interesting

"The 2017 GOLD guidelines generally advise against the routine practice of prescribing supplemental oxygen to stable COPD patients without severe resting hypoxemia"

ďAs democracy is perfected, the office of president represents, more and more closely, the inner soul of the people. On some great and glorious day the plain folks of the land will reach their heartís desire at last and the White House will be adorned by a downright moron.Ē H.L.Mencken 1920
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Dave-OH
Administrator

USA
4072 Posts

Posted - Apr 15 2018 :  10:35:22 AM  Show Profile  Reply with Quote
I found this on the subject

https://consultqd.clevelandclinic.org/long-term-oxygen-treatment-trial-lott-implications-prescribing-supplemental-oxygen-patients-copd/

Dave, Forum Administrator
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micah35
Member

51 Posts

Posted - Apr 15 2018 :  11:23:50 AM  Show Profile  Reply with Quote
Does "resting hypoxemia" refer to just sitting at rest or to while sleeping?
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sslei
Member

100 Posts

Posted - Apr 15 2018 :  1:53:54 PM  Show Profile  Reply with Quote
Does this mean that you should take off your oxygen while resting or sleeping if your sats are up. I can sit in a chair or lay down and unless I get up my sats stay 98 to 99 . if just what does in mean???
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Dave-OH
Administrator

USA
4072 Posts

Posted - Apr 15 2018 :  2:24:54 PM  Show Profile  Reply with Quote
I suggest you talk to your doctor.

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tsainta
Contributing Member

USA
1765 Posts

Posted - Apr 15 2018 :  3:50:44 PM  Show Profile  Reply with Quote
If you have it, use it when you need it. How in the world could you think that a bunch of medical researchers or even your doc would know what YOU need day in and day out, every minute of the day?

Sadly, from my 12 years of experience with oxygen, many who would benefit from it will not get it under the new guidelines. I am sure that I would have been denied oxygen years ago in the earlier stages of my disease, but that would have limited my ability to exercise--and if that had happened, I wouldn't be here to write this now.

Tony-CA

50% of dealing with COPD is common sense.
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Dave-OH
Administrator

USA
4072 Posts

Posted - Apr 15 2018 :  5:31:01 PM  Show Profile  Reply with Quote
When I was evaluated, it was for exercise separate from walking and at rest.

Dave, Forum Administrator
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jmrommes
Contributing Member

1829 Posts

Posted - Apr 15 2018 :  6:24:20 PM  Show Profile  Reply with Quote
There were several major flaws in this study. The most important is that people had to opt in to the study. The eligibility requirements called for people whose resting sats were between 88 and 92 or were 88 to 92 with exercise, and they had to say that they were willing to be randomly selected to NOT getting O2 for anything. At the time of the study, I actually was eligible, but I wouldn't have given up my O2 for exercise for anything! I know there were people who did, but not me. I spoke with the RTs at the U of Iowa who were doing the intake on the study, and when I said no, they made sure I knew that was the right answer from their point of view. There were a lot of people who dropped out of the study and there were other things that made the results somewhat suspect.

At the ATS meeting last year, several of us patients asked questions of the panel that reported on the study, and Bob Wise, who was one of the principal investigators said that the results should be viewed very narrowly: they apply only to people whose sats are in the 88 to 92 range, and his recommendation was to give the patient the choice at that point, along with enough information regarding hypoxia to ensure that they could actually make an informed choice.

It doesn't sound as though the GOLD guidelines followed his recommendation. I'll ask about that when I get a chance......

Exercise not only lets me live, it enables me to have a life.
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tsainta
Contributing Member

USA
1765 Posts

Posted - Apr 16 2018 :  12:40:39 AM  Show Profile  Reply with Quote
Remember Watergate. Follow the money. The new GOLD guidelines have the potential of saving medical payers, including Medicare and Medicaid, tens of millions of dollars, albeit at the expense of patients' health.

Tony-CA

50% of dealing with COPD is common sense.
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rjh-spokane
Rookie

USA
11 Posts

Posted - Apr 16 2018 :  03:49:01 AM  Show Profile  Reply with Quote
Sadly with today's politics there are some people who are more interested in saving money (lower taxes) than the health of those in need.
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MDC
Member

393 Posts

Posted - Apr 16 2018 :  4:39:13 PM  Show Profile  Reply with Quote
Looks like a crock of Bull to me. Just my opinion if your sats get below 88, you need Oxygen. I can sit for a few minutes and keep sats up but HR starts ticking up seriously as 02% goes down. I am taking a course of methylprednisone 21 pill burst now for exacerbation, I went to hospital ER Friday and Physicians Assistant when asked told me to keep my oxygen on and increase some if Pulmonary Dr. Had approved previously. Dr had said to use 3-4 litres while active, and he said only only you know your comfort range. I have 1/3 predicted Lung Volume. BTW, this is quickest comeback I have ever had. I just leave concentrator on 2.5 litres 24/7 and 3 while showering. Keeping HR lower and sat rate high. I agree with Tony "use it if you have it, use it when you need it". BTW I called My Pulmo after release, They said that was Great!
Mike

Knowledge is knowing a tomato is a fruit.
Wisdom is knowing not to put it in a fruit salad.

Edited by - MDC on Apr 16 2018 7:27:33 PM
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Diane545
Member

USA
219 Posts

Posted - Apr 18 2018 :  5:08:03 PM  Show Profile  Reply with Quote
Jean & Tony have some good advice. Plus follow the money. I was just in hospital for 7 days and could not believe the different options I got about oxygen from nurse, respiratory techs, & the CNA that only takes blood pressure. My order was for continuous 02 and I had them telling me my stats were good and didnít need put it on. This is not my first rodeo, many hospitals with infections & exasperations. It bothers me for people who donít know any better and listen to them. I use to be one those people. This use confuse me and I would try not use it as much. Like Tony said, we have take charge and use what works for us. I do my best at around 94/ 95 so that where I try stay. Plus my dr said he takes other things into consideration because it is extra work heart.
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Diane545
Member

USA
219 Posts

Posted - Apr 19 2018 :  5:05:01 PM  Show Profile  Reply with Quote
I am confused. I tried reading this gold table and seems as though they added more items to rate you. Will any of this change what Medicare will pay for? Is there different in 6 min walk test to qualify for 02? Not sure purpose of report and what it used for other than doctors. Thank help.
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jmrommes
Contributing Member

1829 Posts

Posted - Apr 19 2018 :  8:57:41 PM  Show Profile  Reply with Quote
The whole GOLD staging was designed to help docs who are not pulmonologists determine what meds and treatments are appropriate for people at various points in the disease process. When they first began they thought it was a simple matter of FEV1. Then they decided it was FEV1 and number of exacerbations in the last year. And they've added more things for docs to consider. What this really demonstrates is that there are lots of different variations on this disease and we know there are many different phenotypes; we just haven't identified them yet. As we get better at identifying them, we will begin to see individualized treatment plans based on phenotypes that will get more and more specific as we learn more and more. It will get pretty exciting before we're done!

Exercise not only lets me live, it enables me to have a life.
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judiwa
Member

USA
37 Posts

Posted - Apr 20 2018 :  9:51:57 PM  Show Profile  Reply with Quote
SSlei Yes you should talk to your doctor, when I started on O2 I was told to only wear it sleeping or with vigorous exercise because my sats stayed up sitting too. Also you need an overnight oximetry to see how you are doing when you sleep.

judi
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