Transcription of © 2018 Global Initiative for Chronic Obstructive Lung ...
1 COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTE ii Global Initiative FOR Chronic Obstructive LUNG DISEASE Global STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF Chronic Obstructive PULMONARY DISEASE (2018 REPORT) 2018 Global Initiative for Chronic Obstructive Lung Disease, Inc. COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTE GOLD BOARD OF DIRECTORS (2017) GOLD SCIENCE COMMITTEE* (2017) Alvar Agusti, MD, Chair Respiratory Institute, Hospital Clinic, IDIBAPS Univ. Barcelona and Ciberes Barcelona, Spain Bartolome R. Celli, MD Brigham and Women s Hospital Boston, Massachusetts, USA Rongchang Chen, MD Guangzhou Institute of Respiratory Disease Guangzhou, PRC Gerard Criner, MD Temple University School of Medicine Philadelphia, Pennsylvania, USA Peter Frith, MD Repatriation General Hospital, Adelaide, South Australia, Australia David Halpin, MD Royal Devon and Exeter Hospital Devon, UK M.
2 Victorina L pez Varela, MD Universidad de la Rep blica Montevideo, Uruguay Masaharu Nishimura, MD Hokkaido University School of Medicine Sapporo, Japan Claus Vogelmeier, MD University of Marburg Marburg, Germany Claus Vogelmeier, MD, Chair University of Marburg Marburg, Germany Alvar Agusti, MD Respiratory Institute, Hospital Clinic, IDIBAPS Univ. Barcelona and Ciberes Barcelona, Spain Antonio Anzueto, MD University of Texas Health Science Center San Antonio, Texas, USA Peter Barnes, MD National Heart and Lung Institute London, United Kingdom Jean Bourbeau, MD McGill University Health Centre Montreal, Canada Gerard Criner, MD Temple University School of Medicine Philadelphia, Pennsylvania, USA Peter Frith, MD Repatriation General Hospital, Adelaide, South Australia,Australia David Halpin, MD Royal Devon and Exeter Hospital, Devon, United Kingdom Fernando J. Martinez, MD, MS New York-Presbyterian Hospital/ Weill Cornell Medical Center New York, NY USA Nicolas Roche, MD H pital Cochin Paris, France Donald Sin, MD St.
3 Paul s Hospital, University of British Columbia Vancouver, Canada Dave Singh, MD University of Manchester Manchester, UK Robert Stockley, MD University Hospital Birmingham, UK J rgen Vestbo, MD University of Manchester Manchester, England, UK Jadwiga A. Wedzicha, MD Imperial College London London, UK M. Victorina L pez Varela,MDUniversidad de la Rep blica Hospital Maciel Montevideo, Uruguay GOLD PROGRAM DIRECTOR Rebecca Decker, MSJ Fontana, Wisconsin, USA *Disclosure forms for GOLD Committees are posted on the GOLD Website, COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTE Global STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND PREVENTION OF COPD (2017) GOLD NATIONAL LEADERS ALBANIA Professor Perlat Kapisyzi Tirana, Albania ARGENTINA Dr. Eduardo A. Schiavi Buenos Aires, Argentina AUSTRALIA Peter Frith, MD Adelaide, South Australia, Australia AUSTRIA Dr.
4 Otto Chris Burghuber BANGLADESH Prof. Md. Mostafizur Rahman Dhaka, Bangladesh Dr. Kazi S. Bennoor Dhaka, Bangladesh BELGIUM Professor Wim Janssens Leuven, Belgium BRAZIL Dr. Jose Roberto Jardim Sao Paulo, Brazil Aquiles Camelier, MD Fernando Lundgren, MD BULGARIA Dr. Yavor Ivanov Pleven, Bulgaria Dr. Kosta Kostov Sofia, Bulgaria CANADA Dr. Dennis E. O Donnell Kingston, Ontario, Canada CHILE Dr. Manuel Barros CHINA Chunxue Bai, MD, PhD Shanghai, China Jiangtao Lin, MD Beijing, China Fu-Qiang Wen, MD, PhD Chengdu, Sichuan, China Nan-Shan Zhong, MD Guangzhou, China COLOMBIA Alejandro Casas, MD Vice-Director, COPD Department Latin American Thoracic Society CROATIA Neven Miculinic, MD Zagreb, Croatia CZECH REPUBLIC Stanislav Kos, MD, PhD, FCCP Mirosov, Czech Republic Jaromir Musil, MD President, Czech Association Against COPD Vladimir Vondra, MD, PhD Prague, Czech Republic DENMARK Ejvind Frausing Hansen, MD Hvidovre, Denmark DOMINICAN REPUBLIC Dr.
5 Eduardo Gautreau de Windt Provincia Santo Domingo, Dominican Republic EGYPT Hisham Tarraf, MD Cairo, Egypt EL SALVADOR Dr. Victor Castro G mez San Salvador, El Salvador FRANCE Professor Gerard Huchon Paris, France GEORGIA Maia Gotua, MD, PhD Tbilisi, Georgia HONG KONG CHINA David Hui, MD Shatin, Hong Kong ICELAND Thorarinn Gislason, MD, PhD Reykjavik, Iceland Dr Gunnar Gudmundsson Reykjavik, Iceland INDIA Rohini V. Chowgule, MD Mumbai, India Dr. R. Narasimhan, MD Chennai, India INDONESIA Professor Faisal Yunus IRAN Dr. Masjedi Mohammad Reza Tehran, Iran Dr. Mohammad Ashkan Moslehi Shiraz, Iran IRELAND Timothy J. McDonnell, MD Dublin, Ireland ISRAEL Zvi G. Fridlender, MD, MSc Jerusalem, Israel ITALY Professor Lorenzo Corbetta Florence JAPAN Takahide Nagase, MD Tokyo, Japan Michiaki Mishima, MD Kyoto, Japan JORDAN Bashar Nsour, MD Amman, Jordan Jawad Hamad, MD Amman, Jordan KAZAKHSTAN Damilya Nugmanova, MD, PhD, DSci Almaty, Kazakhstan KOREA Yeon-Mok Oh, MD Seoul, South Korea KUWAIT Professor Mousa Khadadah Kuwait University KYRGYZSTAN Talant Sooronbaev, MD Bishkek, Kyrgyzstan MALTA Prof Joseph M Cacciottolo Pieta, Malta MEXICO Dr.
6 J. Javier D az Casta n Zapopan, Jalisco, Mexico MOLDOVA Alexandru Corlateanu, MD, PhD ERS National Delegate Republic of Moldova MONGOLIA Dr. Oyunchimeg Chair of International Cooperation NEPAL Dr. M. R. Pandey Kathmandu, Nepal NETHERLANDS Klaus Rabe, MD Leiden, The Netherlands NEW ZEALAND Harold Rea, MD Auckland, New Zealand NICARAGUA Dr. Jorge Cuadra Sociedad Nicaraguense NORWAY Amund Gulsvik, MD Bergen, Norway Ernst Omenaas, MD Bergen, Norway PAKISTAN Professor Javaid Khan Karachi, Pakistan Dr. Jamil Ur Rehman Tahir Kammanwala, Sialkot Cantt, Dr. Mohammad Osman Yusuf Islamabad, Pakistan PHILIPPINES Teresita S. deGuia, MD Quezon City, Philippines POLAND Ewa Nizankowska-Mogilnicka, MD, PhD, Krakow, Poland Paul Kuca, MD Warsaw, Poland ROMANIA Florin Mihaltan, MD Bucharest, Romania Ruxandra Ulmeanu, MD Bucharest, Romania RUSSIA Alexander Chuchalin, MD Moscow, Russia Professor Dmitri R.
7 Rackita, MD, PhD, Ryazan, Russia COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTE v Professor Alexandre Vizel, MD Kazan, Tatarstan Republic Professor Eugeny Shmelev, MD SINGAPORE Dr. Kian-Chung Ong Wan-Cheng Tan, MD, Chair, Asian Pacific COPD Roundtable SLOVAK REPUBLIC Ruzena Tkacova, MD PhD Kosice, Slovakia SLOVENIA Professor Dr. Stanislav Suskovic Golnik, Slovenia SOUTH AFRICA Professor Irusen Tygerberg, South Africa SPAIN Dr. Patricia Sobradillo SWITZERLAND Daiana Stolz, MD Basel, Switzerland SYRIA Yousser Mohammad, MD Lattakia, Syria TURKEY Professor Ali Kocabas, MD Balcali, Adana, Turkey Prof. Dr. Hakan Gunen Malatya, Turkey URUGUAY Mar Victorina L pez, MD Montevideo, Uruguay VENEZUELA Maria Montes de Oca, MD Caracas, Venezuela VIETNAM Ngo Quy Chau, MD, PhD Hanoi, Vietnam Le Thi Tuyet Lan, MD, PhD Ho Chi Minh City, Vietnam YEMEN Khaled Al-Shair, MD COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTE PREFACE In 2011, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) released a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD.
8 It recommended a major revision in the management strategy for COPD that was first presented in the original 2001 document. Reports released in January 2013, January 2014, January 2015, and January 2016 were based on updated scientific literature published since the completion of the 2011 document but maintain the same treatment paradigm. The 2015 update added an Appendix on Asthma COPD Overlap Syndrome, material prepared jointly by the GOLD and GINA Science Committees. The assessment of COPD proposed by GOLD has been based on the patient s level of symptoms, future risk of exacerbations, the extent of airflow limitation, the spirometric abnormality, and the identification of comorbidities. The ABCD assessment tool of the 2011 GOLD update was a major advance from the simple spirometric grading system of the earlier versions of GOLD because it incorporated multimodality assessment, symptom burden and highlighted the importance of exacerbation prevention in the management of COPD.
9 However, there were some important limitations to this scheme. The ABCD assessment tool performed no better than spirometric grades for mortality prediction or other important health outcomes. To address these and other concerns (while at the same time maintaining consistency and simplicity for the practicing clinician), a refinement of the ABCD assessment tool was proposed in the 2017 GOLD Report that separates spirometric grades from the ABCD groups. Thus, ABCD groups and their associated implications for pharmacotherapy recommendations will be derived exclusively from patient symptoms and their history of exacerbations. The separation of airflow limitation from clinical parameters makes it clearer what is being evaluated and ranked. This revised assessment tool acknowledges the limitations of FEV1 in influencing some therapeutic decisions for individualized patient care and highlights the importance of patient symptoms and exacerbation risks in patients with COPD.
10 Spirometry remains key in the diagnosis, prognostication and treatment with nonpharmacologic therapies. The GOLD report has been used worldwide as a strategy document for healthcare professionals to use as a tool to implement effective management programs based on local healthcare systems. The ABCD assessment tool has been used by many to structure their assessment of COPD symptom burden and create treatment plans. A summary of publications that have examined the ABCD grading system since its first presentation in 2011 is provided in the table on the next page. Additional evidence generated from using the original and the revised system proposed in the 2017 GOLD Report will continue to be evaluated by the GOLD committees and management strategy recommendations will be modified as required as new data become available.
