Prevention of Chronic Obstructive Pulmonary Disease 2020 ...

1 Global Strategy for the Diagnosis, Management, andPrevention of Chronic Obstructive Pulmonary Disease 2020 REPORTCOPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTEi GLOBAL INITIATIVE FOR Chronic Obstructive LUNG Disease GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND Prevention OF Chronic Obstructive Pulmonary Disease (2020 REPORT) 2020 Global Initiative for Chronic Obstructive Lung Disease , Inc. COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTEii GOLD BOARD OF DIRECTORS (2019) GOLD SCIENCE COMMITTEE* (2019) Alvar Agusti, MD, Chair Respiratory Institute, Hospital Clinic, IDIBAPS Univ. Barcelona and Ciberes Barcelona, Spain Richard Beasley, MD Medical Research Institute of NZ, Wellington, New Zealand 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 Flinders University Adelaide, 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 Maria Montes de Oca, MD Hospital Universitario de Caracas Universidad Central de Venezuela Caracas, Venezuela Kevin Mortimer, MD Liverpool School of Tropical Medicine Liverpool, UK Sundeep Salvi, MD Chest Research Foundation Pune, India 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 South Texas Veterans Health Care System, University of Texas, Health San Antonio, Texas, USA Peter Barnes, DM, FRS National Heart & Lung Institute, Imperial College 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 (retired 2019) Flinders University Adelaide, Australia David Halpin, MD Royal Devon and Exeter Hospital Devon, UK MeiLan Han, MD MS University of Michigan Ann Arbor, MI, USA Fernando J.

3 Martinez, MD MS New York-Presbyterian Hospital/ Weill Cornell Medical Center New York, NY, USA Maria Montes de Oca, MD Hospital Universitario de Caracas Universidad Central de Venezuela Caracas, Venezuela Alberto Papi, MD University of Ferrara Ferrara, Italy Ian Pavord, MA DM Respiratory Medicine Unit and Oxford Respiratory NIHR Biomedical Research Centre, Nuffield Department of Medicine University of Oxford Oxford, UK Nicolas Roche, MD University Paris Descartes H pital Cochin APHP Paris, France Don D. Sin, MD St. Paul s Hospital, University of British Columbia Vancouver, Canada Dave Singh, MD University of Manchester Manchester, UK Robert Stockley, MD University Hospital Birmingham, UK M. Victorina L pez Varela, MD Universidad de la Rep blica Hospital Maciel Montevideo, Uruguay J rgen Vestbo, MD University of Manchester Manchester, England, UK Jadwiga A.

4 Wedzicha, MD Imperial College London London, UK GOLD EXECUTIVE DIRECTOR GOLD PROJECT MANAGER EDITORIAL ASSISTANCE Rebecca Decker, MSJ Fontana, Wisconsin, USA Katie Langefeld, BS Illinois, USA Ruth Hadfield, PhD Sydney, Australia Michael Hess, MPH, RRT, RPFT, Kalamazoo, MI, USA *Disclo sure fo rms fo r GOLD Committees are posted on the GOLD Website, COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTEiii GLOBAL STRATEGY FOR THE DIAGNOSIS, MANAGEMENT, AND Prevention OF COPD (2020) GOLD ASSEMBLY The GOLD National Leaders are individu a ls from around the world with an interest in promoting the goals of GOLD within their home country. The group meets periodically to share information about programs of h ea lth education, COPD management, and Prevention . ALBANIA Professor Perlat Kapisyzi Tirana, Albania ARGENTINA Dr Eduardo A.

5 Schiavi Buenos Aires, Argentina AUSTRALIA Peter Frith, MD Adelaide, South Australia, Australia AUSTRIA Dr Otto Chris Burghuber BANGLADESH Prof Md Mostafizur Rahman Dhaka, Bangladesh Dr Kazi S. Bennoor Dhaka, Bangladesh BELGIUM Professor Wim Janssens Leuven, Belgium BRAZIL Jo se Rob erto Ja rd i m, MD Aquiles Camelier, MD Sao Paulo, Brazil 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 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.

6 , 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 Eduardo Gautreau de Windt Provincia Santo Domingo, Dominican Republic EGYPT Tarek Safwat, MD, FCCP 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 GREECE Prof. Konstantinos Kostikas Ioannina, Greece HONG KO NG 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 Dr. Kshitij Agarwal, MD Delhi, India INDONESIA Professor Faisal Yunus IRAN Dr Masjedi Mohammad Reza Tehran, Iran Mohammad Ashkan Moslehi, MD Shiraz, Iran IRELAND Timothy J.

7 McDonnell, MD Dublin, Ireland ISRAEL Zvi G. Fridlender, MD, MSc Jerusalem, Israel ITALY Professor Lorenzo Corbetta Florence, Italy JAPAN Takahide Nagase, MD Tokyo, Japan Michiaki Mishima, MD Kyoto, Japan JORDAN Bashar Nsour, MD 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. 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, Nep al NETHERLANDS COPYRIGHTED MATERIAL- DO NOT COPY OR DISTRIBUTEiv Klaus Rabe, MD Leiden, The Netherlands NEW ZEALAND Harold Rea, MD Auckland, New Zealand NICARAGUA Dr.

8 Jorge Cuadra Sociedad Nicaraguense NORWAY Amund Gulsvik, MD Ernst Omenaas, MD Bergen, Norway PAKISTAN Professor Javaid Khan Karachi, Pakistan Dr. Jamil Ur Rehman Tahir Kammanwala, Sialkot Cantt, Pakistan 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 Prof Zaurbek Aisanov, MD Alexander Chuchalin, MD Moscow, Russia Prof Dmitri R. Rackita, MD, PhD Ryazan, Russia Prof Alexandre Vizel, MD Kazan, Tatarstan Republic, Russian Federation Svetlana Ovcharenko, MD Maria Sanzharovskaya, MD Prof Eugeny Shmelev, MD SINGAPORE Kian-Chung Ong, MD Wan-Cheng Tan, MD, Chair, Asian Pacific COPD Roundtable SLOVAK REPUBLIC Ruzena Tkacova, MD PhD Kosice, Slovakia SLOVENIA Professor Dr.

9 Stanislav Suskovic Golnik, Slovenia SOUTH AFRICA Professor Irusen Tygerberg, South Africa SPAIN Dr Patricia Sobradillo SWITZERLAND Daiana Stolz, MD Basel, Switzerland SYRIA Yousser Moh a mma d , MD Lattakia, Syria TRINIDAD & TOBAGO Dr. Sateesh Madhava Sakhamuri The University of the West Indies, Trinidad and Tobago TURKEY Prof Dr. Hakan Gunen Malatya, Turkey Professor Ali Kocabas, MD Balcali, Adana, Turkey Nurdan Kokturn, MD Ankara, 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 DISTRIBUTEv preface The GOLD report is revised annually and has been used worldwide by healthcare professionals as a strategy document and tool to implement effective management programs based on local healthcare systems.

10 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. 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.