Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report

Abstract

This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, GlobalInitiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.

Influences of patient education on exacerbations and hospital admissions in patients with COPD – a longitudinal national register study

“…This indicates the importance of effective management of exacerbations and deterioration in patients affected by COPD. This finding is in-line with recent GOLD guidelines, that the best predictor of frequent exacerbations is a history of earlier treated events [1,25]. It is suggested that written negotiated action plans for worsening symptoms may lead to less respiratory-related hospitalization and all-cause hospitalizations as well as improved health status.…”

“…Patients were included if they had not participated in the intervention at baseline. The independent variables are from baseline. Participation in patient education programParticipation in smoking cessation program UnivariableMultivariableUnivariableMultivariableIndependent variablesOR (95% CI) p OR (95% CI) p OR (95% CI) p OR (95% CI) p Constant 0.456 0.70Age, divided by 10 years1.04 (0.93, 1.17) 0.47 0.76 (0.62, 0.93) 0.0060.76 (0.62, 0.93) 0.006Gender (1 = man, 2 = woman)0.99 (0.80, 1.22) 0.89 1.37 (0.97, 1.95) 0.078 Social situation (0 = living alone; 1 = cohabiting)0.88 (0.67, 1.16) 0.37 0.79 (0.51, 1.23) 0.30 FEV 1 % of predicted value0.99 (0.99, 1.00) 0.045 1.00 (0.99, 1.01) 0.80 Exacerbations the last 12 months1.10 (1.02, 1.19) 0.0201.11 (1.02, 1.21) 0.0151.02 (0.89, 1.16) 0.79 Hospital admissions due to COPD the last 12 months1.14 (0.95, 1.35) 0.16 0.94 (0.65, 1.36) 0.73 Smoking, dichotomized0.69 (0.55, 0.87) 0.0020.69 (0.52, 0.85) 0.001  Dyspne_mMRC.01 1 Dyspne_mMRC.0 [1]1.34 (0.90, 2.01) 0.155 1.02 (0.47, 2.25) 0.95…”

“…Chronic obstructive pulmonary disease (COPD) is a progressive and life-limiting disease which is predicted to be the third-leading cause of death by the year of 2020, globally [1]. Recent GOLD guidelines recommend combined COPD assessment, where COPD first is classified into four spirometric stages and then severity grading due to successively increasing symptoms and exacerbations [2,3].…”

Invited Review Series Introduction

“…Recent studies have shown that home NIV may improve survival and the exacerbation rate [5,9], and for this reason this technique has also been mentioned as a potential treatment of chronic hypercapnic respiratory failure in the recent GOLD document [10]. Five further reviews will deal with this issue.…”

Frailty, Comorbidity, and COPD

“…The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines COPD as "a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases" (2). COPD can directly lead to or accelerate co-morbidities through hypoxia, dyspnea, polycythemia, pulmonary hypertension, and decreased activity ( Figure 1).…”