COPD

GOLD Releases Updated COPD Recommendations

The Global Initiative for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease (GOLD) has updated its recommendations for the management of chronic obstructive pulmonary disease (COPD).
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Among the recommendations and changes to the document:

  • “ABCD” groups should be derived from patient symptoms and history of exacerbations, and remain separate from spirometric assessment.
  • FEV1 is important to the prediction of hospitalization and mortality, but its limits in making treatment decisions for individualized patient care should be acknowledged.
  • While past GOLD reports only made initial therapy recommendations, the current report offers strategies for the escalation of pharmacological treatments in each of the ABCD groups, and the concept of de-escalation is introduced.
  • Non-pharmacologic treatments, such as pulmonary rehabilitation, exercise training, oxygen therapy, vaccinations, palliative care, and interventional bronchoscopy and surgery, are presented.
  • Comorbidities, including cardiovascular disease, osteoporosis, anxiety, depression, gastroesophageal reflux, and obstructive sleep apnea, should be recognized and managed with the goal of minimizing polypharmacy.

The new recommendations are GOLD’s third revision of its original document, published in 2001. The recommendations were based on a literature review of available studies conducted up to October 2016.

—Michael Potts

Reference:

Vogelmeier CF, Criner GJ, Martinez FJ. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report: GOLD executive summary [published online January 27, 2017]. AM J RESPIR CRIT CARE MED. http://www.atsjournals.org/doi/abs/10.1164/rccm.201701-0218PP.