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

Headnote

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 themaincontents of thesecond5-year revision of theGOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry isrequired for the clinical diagnosis ofCOPDto avoid misdiagnosis and to ensure proper evaluation of severity of airflowlimitation. Thedocumenthighlights that theassessment of thepatientwith COPDshould always includeassessment of (1)symptoms,(2)severityof airflow limitation, (3) history of exacerbations, and (4) comorbidities. Thefirst threepointscanbeusedtoevaluatelevelof symptomsandrisk of futureexacerbations,andthis isdoneinawaythatsplitspatientswith 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 aswell asCOPDin the presence of comorbidities. The revised document also contains a newsection on exacerbations of COPD. TheGOLDinitiative will continue tobringCOPDto the attention of all relevant shareholdersandwillhopefullyinspire futurenationaland local guidelines on the management of COPD.

Keywords: COPD; clinical assessment; COPD management; exacerbations; comorbidities

CONTENTS

Introduction

Summary of New Recommendations

Levels of Evidence

1. Definition and Overview

Key Points

Definition

Burden of COPD

Factors That Influence Disease Development and Progression

Pathology, Pathogenesis, and Pathophysiology

2. Diagnosis and Assessment

Key Points

Diagnosis

Assessment of Disease

Differential Diagnosis

3. Therapeutic Options

Key Points

4. Management of Stable COPD

Key Points

Introduction

Identify and Reduce Exposures

Treatment of Stable COPD

Nonpharmacologic Treatment

Pharmacologic Treatment

Monitoring and Follow-up

5. Management of Exacerbations

Key Points

Definition

Diagnosis

Assessment

Treatment Options

Hospital Discharge and Follow-up

Home Management of Exacerbations

Prevention of COPD Exacerbations

6. COPD and Comorbidities

Key Points

Introduction

Cardiovascular Diseases

Osteoporosis

Anxiety and Depression

Lung Cancer

Infections

Metabolic Syndrome and Diabetes

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is a major public health problem. In 2020, COPDis projected to rank fifth worldwide in terms of burden of disease and third in terms of mortality. Although COPD has received increasing attention from the medical community in recent years, it is still relatively unknown or ignored by the public as well as public health and government...