The Global Initiative for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease (GOLD) has published its 2017 report online ahead of print in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine.
The report, which represents the third revision of the initial GOLD document published in 2001, includes new recommendations for assessing COPD, strategies for escalation and de-escalation of therapies, a discussion of nonpharmacologic therapies and a section on COPD and common comorbidities.
“Since it was first published, the GOLD report has changed how patients with COPD are treated,” said Jadwiga Wedzicha, MD, editor-in-chief of the American Journal of Respiratory and Critical Care Medicine, professor of respiratory medicine at the National Heart and Lung Institute in London and one of the report’s authors. “The latest report revises the GOLD document in important ways based on the latest scientific and clinical studies.”
Among the most notable changes in the 2017 GOLD Report:
- Separation of spirometric values from the “ABCD” grouping of patients by symptoms and risk of exacerbations. Forced expiratory volume in one second (FEV1), the authors write, is an “important parameter at the population level” in predicting hospitalization and mortality, but keeping results separate “acknowledges the limitations of FEV1 in making treatment decisions for individualized patient care and highlights the importance of patient symptoms and exacerbation risks in guiding therapies in COPD.”
- Inclusion of specific escalation and de-escalation strategies for pharmacological treatments. Past GOLD reports only made initial therapy recommendations. However, the authors note, many patients continue to experience persistent symptoms. Though less common, in some patients symptoms resolve, indicating that they might benefit from de-escalation of therapy. The panel made its recommendations “based on the level of symptoms and an individual’s risk of exacerbations.”
- Addition of a comprehensive review of non-pharmacologic treatment of COPD. GOLD 2017 notes the benefits and makes recommendations for the best use of these treatments, which include pulmonary rehabilitation, exercise training, oxygen therapy, vaccinations, interventional bronchoscopy and surgery and end-of-life and palliative care.
- Recognition that COPD often coexists with other diseases, including cardiovascular disease, osteoporosis, anxiety and depression, gastroesophageal reflux and obstructive sleep apnea. These comorbidities should be treated, the authors write, “because they independently affect mortality and hospitalizations.” At the same time, “the presence of comorbidities should not alter COPD treatment.” The goal of treating COPD patients with comorbidities, they add, is “to ensure simplicity of treatment and minimize polypharmacy.”
The international panel of 22 COPD experts who wrote the 2017 GOLD Report based their recommendations on peer-reviewed publications to October 2016.
I am not sure that FEV1 have to be completely excluded from ABCD classification in treatment decisions.
Also I am not sure in cut off blood eosinophils for treatment decision according corticosteroids meanwhile that normal values are from 0-4%