Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary

Abstract

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

Diagnosis of asthma–COPD overlap: the five commandments

“…The approved indication for ICS in COPD is the treatment of patients with impaired lung function (usually forced expiratory volume in 1 s (FEV1) <60% predicted) and frequent exacerbations, but the recent Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategic document indicates that even in these cases, dual bronchodilation should be preferred to the use of a combination containing ICS. However, long-acting β 2 -agonists/ICS may be the first choice of treatment in patients with a history and/or findings suggestive of asthma-COPD overlap (ACO) and/or high blood eosinophil counts [3]. Therefore, the history and/or findings of ACO are crucial for the therapeutic decision to prescribe an ICS or not in COPD but no clear indication is provided about what history and/or findings of ACO mean [3], and this has been highlighted as one of the limitations of the new proposal for pharmacological treatment [4].…”

“…However, long-acting β 2 -agonists/ICS may be the first choice of treatment in patients with a history and/or findings suggestive of asthma-COPD overlap (ACO) and/or high blood eosinophil counts [3]. Therefore, the history and/or findings of ACO are crucial for the therapeutic decision to prescribe an ICS or not in COPD but no clear indication is provided about what history and/or findings of ACO mean [3], and this has been highlighted as one of the limitations of the new proposal for pharmacological treatment [4]. In addition, the same document indicates that regular treatment with ICS increases the risk of pneumonia [3].…”

“…Therefore, the history and/or findings of ACO are crucial for the therapeutic decision to prescribe an ICS or not in COPD but no clear indication is provided about what history and/or findings of ACO mean [3], and this has been highlighted as one of the limitations of the new proposal for pharmacological treatment [4]. In addition, the same document indicates that regular treatment with ICS increases the risk of pneumonia [3]. Therefore, the clinician must evaluate the risk/ benefit ratio in each patient before the prescription of an ICS, and the diagnosis of ACO plays a fundamental role in this evaluation.…”

From COPD epidemiology to studies of pathophysiological disease mechanisms: challenges with regard to study design and recruitment process

“…non-rapid decline (B), thus the predefined levels of FEV 1 decline in these groups were separated by an empty interval. The Global Initiative for Obstructive Lung Disease (GOLD) spirometric criterion for COPD was used [11]. …”

“…COPD was defined by the spirometric criteria FEV 1 /VC < 0.70, using the highest value pre- or post-bronchodilation. Disease severity was classified according to the GOLD guidelines [11]; grade 2–3 includes subjects with FEV 1  < 80 and ≥30 percent of predicted value. Swedish spirometric reference values for FEV 1 were used [13], corresponding well to FEV 1 in a symptom-free population of Northern Sweden [14].…”