A review of the GOLD guidelines for the diagnosis and treatment of patients with COPD

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the USA, and represents a major health, social and economic burden. COPD is underdiagnosed and often misdiagnosed, which likely contributes to the continuing increases in the prevalence, morbidity and mortality associated with this disease. This is unfortunate because whereas COPD cannot be cured, it can be treated effectively, particularly during the earlier stages of the disease. Evidence-based guidelines, developed to assist in the prevention, diagnosis and management of COPD, are available to healthcare professionals interested in learning more about COPD. These guidelines are updated and revised on a regular basis to reflect recent advances in our understanding of the pathophysiology of and treatments available for COPD. Nevertheless, primary-care physicians have reported a lack of awareness of the fundamental concepts underpinning the optimal treatment and management of COPD presented in the guidelines. Thus, the objective of this article is to summarise key physiologic, diagnostic and management concepts provided in the most recent update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, which were published in November 2006.

The Adjunctive Effect of Nebulized Furosemide in COPD Exacerbation: A Randomized Controlled Clinical Trial

“…Subjects in the intervention group had higher baseline P aCO 2 and bicarbonate than the placebo group, and this may indicate more severe and prolonged exacerbation in the intervention group. These patients may require more time to compensate and decrease P aCO 2 , despite greater improvement in breathing frequency.…”

“…[1][2][3][4] In spite of the prevalence and burden of dyspnea, its effective management remains a challenge for physicians and calls for the exploration of new treatments. 3,5 Irreversible underlying changes to the lungs in patients with COPD often make it difficult to improve dynamic ventilatory mechanics in acute dyspnea states.…”

Profiling hospital performance to monitor the quality of care: the case of COPD

“…However, it needs to be considered that information on previous COPD was available only for those patients surviving at the time of study inclusion, thus introducing a potential bias in the comparison between individuals with or without past COPD exacerbation. Otherwise, previous COPD hospitalisation could be considered a marker of more frequent contacts with specialist care and access to appropriate treatment like corticosteroids or long-acting bronchodilators, which are associated with lower mortality [10].…”

“…In-hospital mortality is high and patients experience extended lengths of stay [7,9]. Current guidelines identify evidence-based management strategies to be implemented at hospital level to improve outcomes for exacerbated COPD patients, but little is known on their current application and on factors potentially influencing outcomes [10]. As a unique and stimulating initiative in Europe, the UK national audit programme for acute exacerbation of COPD found wide variability in 90-day mortality unexplained by clinical factors, and demonstrated an association between high-quality specialised hospital care and better outcomes [11,12].…”

A comparison of the intensive care unit outcomes of pneumonectomy and lobectomy patients with lung cancer

“…Furthermore, the sedation and agitation levels of the patients were determined according to the Richmond AgitationSedation Scale (RASS). [10] All of the patients' data was recorded retrospectively from an electronic database and written medical records, and information regarding age, gender, body mass index (BMI), comorbid diseases such as chronic obstructive pulmonary diseases (COPD) [11] diabetes mellitus (DM), arrhythmia [atrial fibrillation (AF) and supraventricular tachycardia), hypertension (HT), type of surgery (pneumonectomy or lobectomy), and the preoperative PFT results of both groups was obtained. Those patients who were 70 years old or older were deemed to be elderly.…”