Global Initiative for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease. The 2020 GOLD Science Committee Report on COVID-19 and Chronic Obstructive Pulmonary Disease

Abstract

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised many questions about the management of patients with chronic obstructive pulmonary disease (COPD) and whether modifications of their therapy are required. It has raised questions about recognizing and differentiating coronavirus disease (COVID-19) from COPD given the similarity of the symptoms. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) Science Committee used established methods for literature review to present an overview of the management of patients with COPD during the COVID-19 pandemic. It is unclear whether patients with COPD are at increased risk of becoming infected with SARS-CoV-2. During periods of high community prevalence of COVID-19, spirometry should only be used when it is essential for COPD diagnosis and/or to assess lung function status for interventional procedures or surgery. Patients with COPD should follow basic infection control measures, including social distancing, hand washing, and wearing a mask or face covering. Patients should remain up to date with appropriate vaccinations, particularly annual influenza vaccination. Although data are limited, inhaled corticosteroids, long-acting bronchodilators, roflumilast, or chronic macrolides should continue to be used as indicated for stable COPD management. Systemic steroids and antibiotics should be used in COPD exacerbations according to the usual indications. Differentiating symptoms of COVID-19 infection from chronic underlying symptoms or those of an acute COPD exacerbation may be challenging. If there is suspicion for COVID-19, testing for SARS-CoV-2 should be considered. Patients who developed moderate-to-severe COVID-19, including hospitalization and pneumonia, should be treated with evolving pharmacotherapeutic approaches as appropriate, including remdesivir, dexamethasone, and anticoagulation. Managing acute respiratory failure should include appropriate oxygen supplementation, prone positioning, noninvasive ventilation, and protective lung strategy in patients with COPD and severe acute respiratory distress syndrome. Patients who developed asymptomatic or mild COVID-19 should be followed with the usual COPD protocols. Patients who developed moderate or worse COVID-19 should be monitored more frequently and accurately than the usual patients with COPD, with particular attention to the need for oxygen therapy.

From GOLD 0 to Pre-COPD

“…The diagnosis of chronic obstructive pulmonary disease (COPD) currently requires the demonstration of poorly reversible airflow limitation, defined as a post-bronchodilator FEV 1 /FVC <0.7 ( 1 – 3 ). Although some have argued that the lower limit of normal rather than a fixed value to define obstruction may be more accurate and theoretically more appropriate, recent pooled data from multiple NIH cohorts demonstrate that the fixed FEV 1 /FVC ratio <0.70 provides discrimination of COPD-related hospitalization and mortality that is equal to or better than other thresholds and the lower limit of normal ( 4 ).…”

Cardiorespiratory coupling is associated with exercise capacity in patients with chronic obstructive pulmonary disease

“…The sample included patients who underwent regular follow-up as out-patients at CGMH between January 2019 and January 2020. Inclusion criteria included clinical diagnosis of COPD based on the Global Initiative for Obstructive Lung Disease Criteria (GOLD) [ 24 ] and post-bronchodilator FEV1 < 80% of the predicted normal value via diagnostic spirometry. Other inclusion criteria were age ≥ 40 years without known heart disease.…”

Flow Cytometry: From Experimental Design to Its Application in the Diagnosis and Monitoring of Respiratory Diseases

“…Guidelines provided by European Respiratory Society (ERS), American Thoracic Society (ATS) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend the use of lung function tests and imaging tests in the diagnosis of respiratory diseases [ 86 , 87 ]. For instance, spirometry test is relevant for COPD diagnosis, and though it is an excellent tool to support a clinical decision, to have quality spirometric measurements, a consensus among manufacturers, clinicians, operators, and researchers is requested in order to improve the accuracy and precision of the test [ 88 , 89 , 90 ].…”