Table 1 Summary of recommendations in new GOLD document comparing to old ones
From: GOLD 2017 recommendations for COPD patients: toward a more personalized approach
Topic | Previous Documents | 2017 Document |
|---|---|---|
Definition of COPD | “COPD, a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Exacerbations and comorbidities contribute to the overall severity in individual patients” | Revised and simplified, to include the impact of respiratory symptoms and the role of lung tissue and airway abnormalities in the development of COPD |
Disease development and progression | Genes, age, gender, low growth, exposure to particles, socioeconomic status, bronchial hyper-reactivity and infections are discussed | COPD development is further discussed, including new insights on lung development and on interactions of host factors and environmental exposures |
COPD assessment tool | Based on the ABCD assessment tool, considering severity of airflow obstruction (FEV1), severity of symptoms (CAT, mMRC questionnaire) and history of exacerbations (>1) | ABCD assessment tool has been modified to utilize only respiratory symptoms and history of exacerbation |
Role of spirometry | Provides fundamental information for the diagnosis, prognosis, the assessment of the disease, and the pharmacologic and non-pharmacologic management | The role has been revised. It is now fundamental in the diagnosis, prognosis, and discussion around non-pharmacologic treatment such as surgery |
Non-pharmacologic therapies | Rehabilitation, oxygen therapy, ventilatory support, surgical treatment and end-of-life care are discussed | Evidence has been added on evaluation of inhaler technique, self-management, integrated care, and bronchoscopic interventions |
Pharmacologic treatment | Treatment of stable COPD is individualized according to ABCD categories, with different options for each category | Shifts towards a more personalized approach (revised ABCD assessment tool, escalation and de-escalation strategies) |
Comorbidities | Included in the definition of the disease, and discussed in a specific chapter | The complex issues of multimorbidity and polypharmacy have been added and discussed |