COPD Guidelines: A Review of the 2018 GOLD Report

Abstract

Global Strategy for the Diagnosis, Management, and Prevention of COPD 2018 is a consensus report published periodically since 2001 by an international panel of health professionals from respiratory medicine, socioeconomics, public health, and education comprising the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The GOLD documents endeavor to incorporate latest evidence and expert consensus and are intended for use as "strategy documents" for implementation of effective care for chronic obstructive lung disease (COPD) on a global level. The GOLD 2018 report defines COPD as a "common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities, usually caused by significant exposure to noxious particles or gases," with the criteria of "persistent respiratory symptoms" being a new and controversial inclusion since 2017. With the availability of newer pharmacotherapy options, treatment recommendations are made on the basis of a review of the latest literature and directed by symptom burden and health care utilization. Apart from the change in definition, a major shift in the recommendations is the exclusion of severity of airflow limitation as one of the major factors in guiding therapy. We review the salient features of the GOLD 2018 document and provide commentary on features that merit further discussion based on our clinical experience and practice as well as literature review current as

Chinese herbal medicine reduces the risk of urinary incontinence in patients with chronic obstructive pulmonary disease: A population‐based retrospective cohort study

“…In terms of COPD medications, short-acting and long-acting bronchodilators, ICS, and triple therapy with the addition of macrolide or theophylline are established as standard pharmacological therapies for COPD. 18 Antimuscarinic drugs and beta-adrenergic agonists are bronchodilators, which are also the main pharmacological agents available for urgency incontinence. In the medication analysis shown in Table 4, longacting bronchodilators (LABA or LAMA) along with their combined treatment with CHM and short-acting bronchodilators (SABA or SAMA) reduced the risk of urinary incontinence, whereas ICS had no protective effect compared with no treatment.…”

Effect of high-flow nasal therapy during early pulmonary rehabilitation in patients with severe AECOPD: a randomized controlled study

“…Patients who had received a diagnosis of COPD exhibited a post-bronchodilator forced expiratory volume in the first second (FEV1)/ forced vital capacity (FVC) ratio of ≤70%. All COPD patients were in category C or D according to the combined COPD assessment using new GOLD guidelines [24]. All participants were aged 40~90 years and were ambulatory by 48 h after admission for AECOPD at the time of inclusion.…”

Evaluation of right ventricular function in patients with copd and its correlation with respiratory functions

“…A post-bronchodilator FEV1/ FEVC ratio of <70% was considered as COPD. Post-bronchodi-lator FEV1 values of ≥80%, 50%≤FEV1<80%, 30%≤FEV1<50% and <30% were classified as mild (GOLD stage 1), moderate (GOLD stage 2), severe (GOLD stage 3) and very severe (GOLD stage 4) COPD, respectively [1]. The patients with GOLD stages 1 and 2 COPD were included in Group 1, while Group 2 included the cases of GOLD stages 3 and 4.…”

“…Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease characterized by progressive respiratory symptoms and airflow limitation [1]. Numerous comorbid conditions bearing similar risk factors and systemic inflammation accompany COPD.…”

“…These comorbidities may occur at any time during the disease and may significantly alter its severity and prognosis. The most commonly encountered and the most important one among these comorbidities are cardiovascular disorders [1][2][3]. They worsen the overall quality of life and survival rates of patients with COPD, being responsible for 20-25% of all COPD-related deaths.…”