Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a global health problem, and since 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document highlights that the assessment of the patient with COPD should always include assessment of (1) symptoms, (2) severity of airflow limitation, (3) history of exacerbations, and (4) comorbidities. The first three points can be used to evaluate level of symptoms and risk of future exacerbations, and this is done in a way that splits patients with COPD into four categories-A, B, C, and D. Nonpharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority, and a separate section in the document addresses management of comorbidities as well as COPD in the presence of comorbidities. The revised document also contains a new section on exacerbations of COPD. The GOLD initiative will continue to bring COPD to the attention of all relevant shareholders and will hopefully inspire future national and local guidelines on the management of COPD.

Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

“…The subgroup of individuals with COPD was identified based on the presence of airflow limitation defined as a ratio of forced expiratory volume in one second (FEV 1 ) to forced vital capacity (FVC) less than 0.7. 10 Only pre-bronchodilator lung function measurements were available. After the examination, all participants in the CGPS with airflow limitation were advised to contact their general practitioners.…”

“…These individuals were classified according to the Global Initiative for Obstructive Lung Disease (GOLD) level of airflow limitation as GOLD 1-4. 10 In addition, as sensitivity analysis, individuals with COPD were further classified as GOLD A-D based upon the presence of breathlessness, airflow limitation, and previous exacerbations. 10 Linkage to National Registers Our study population was linked to the national Danish Register of Medicinal Product Statistics (DRMPS), 11 with allinclusive information on drugs dispensed (i.e., physically retrieved) at all Danish pharmacies from 1995 through December, 31,2009.…”

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

“…[37] Therefore, reducing exacerbations has been established as a priority in the treatment of COPD. [38] Finally, CAT is a recently developed questionnaire to quantify the impact of COPD on a patient’s life, and how this changes over time. [39] Despite its short life, this instrument has been validated in several different scenarios including stable disease,[40] during exacerbations,[41] associated with certain comorbidities,[42] and after some interventions such as pulmonary rehabilitation.…”

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

“…The disease is characterized by persistent airflow obstruction, resulting from inflammation and remodelling of the airways, and may include development of emphysema. Furthermore, systemic disease manifestations and acute exacerbations influence disease burden and mortality risk 3. Extending the classical descriptions of the ‘pink puffer’ and ‘blue bloater’, recent unbiased statistical approaches4, 5 support the concept that body weight and body composition discriminate pulmonary phenotypes and are predictors of outcome.…”