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

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          Abstract

          This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) 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; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.

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          Most cited references 191

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          Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

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            Prevalence and outcomes of diabetes, hypertension and cardiovascular disease in COPD.

            Chronic obstructive pulmonary disease (COPD) is associated with important chronic comorbid diseases, including cardiovascular disease, diabetes and hypertension. The present study analysed data from 20,296 subjects aged > or =45 yrs at baseline in the Atherosclerosis Risk in Communities Study (ARIC) and the Cardiovascular Health Study (CHS). The sample was stratified based on baseline lung function data, according to modified Global Initiative for Obstructive Lung Disease (GOLD) criteria. Comorbid disease at baseline and death and hospitalisations over a 5-yr follow-up were then searched for. Lung function impairment was found to be associated with more comorbid disease. In logistic regression models adjusting for age, sex, race, smoking, body mass index and education, subjects with GOLD stage 3 or 4 COPD had a higher prevalence of diabetes (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.1-1.9), hypertension (OR 1.6, 95% CI 1.3-1.9) and cardiovascular disease (OR 2.4, 95% CI 1.9-3.0). Comorbid disease was associated with a higher risk of hospitalisation and mortality that was worse in people with impaired lung function. Lung function impairment is associated with a higher risk of comorbid disease, which contributes to a higher risk of adverse outcomes of mortality and hospitalisations.
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              An official American Thoracic Society public policy statement: Novel risk factors and the global burden of chronic obstructive pulmonary disease.

              Although cigarette smoking is the most important cause of chronic obstructive pulmonary disease (COPD), a substantial proportion of COPD cases cannot be explained by smoking alone. To evaluate the risk factors for COPD besides personal cigarette smoking. We constituted an ad hoc subcommittee of the American Thoracic Society Environmental and Occupational Health Assembly. An international group of members was invited, based on their scientific expertise in a specific risk factor for COPD. For each risk factor area, the committee reviewed the literature, summarized the evidence, and developed conclusions about the likelihood of it causing COPD. All conclusions were based on unanimous consensus. The population-attributable fraction for smoking as a cause of COPD ranged from 9.7 to 97.9%, but was less than 80% in most studies, indicating a substantial burden of disease attributable to nonsmoking risk factors. On the basis of our review, we concluded that specific genetic syndromes and occupational exposures were causally related to the development of COPD. Traffic and other outdoor pollution, secondhand smoke, biomass smoke, and dietary factors are associated with COPD, but sufficient criteria for causation were not met. Chronic asthma and tuberculosis are associated with irreversible loss of lung function, but there remains uncertainty about whether there are important phenotypic differences compared with COPD as it is typically encountered in clinical settings. In public health terms, a substantive burden of COPD is attributable to risk factors other than smoking. To prevent COPD-related disability and mortality, efforts must focus on prevention and cessation of exposure to smoking and these other, less well-recognized risk factors.
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                Author and article information

                Contributors
                (View ORCID Profile)
                Journal
                American Journal of Respiratory and Critical Care Medicine
                Am J Respir Crit Care Med
                American Thoracic Society
                1073-449X
                1535-4970
                March 2017
                March 2017
                : 195
                : 5
                : 557-582
                Affiliations
                [1 ]University of Marburg, Member of the German Center for Lung Research (DZL), Marburg, Germany
                [2 ]Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
                [3 ]New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
                [4 ]University of Texas Health Science Center, San Antonio, Texas
                [5 ]South Texas Veterans Health Care System, San Antonio, Texas
                [6 ]National Heart and Lung Institute, Imperial College, London, United Kingdom
                [7 ]McGill University Health Centre, McGill University, Montreal, Quebec, Canada
                [8 ]Brigham and Women’s Hospital, Boston, Massachusetts
                [9 ]State Key Lab for Respiratory Disease, Guangzhou Institute of Respiratory Disease, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
                [10 ]University of Leuven, Leuven, Belgium
                [11 ]University of Modena and Reggio Emilia, Modena, Italy
                [12 ]Faculty of Medicine, Flinders University, Bedford Park, South Australia, Australia
                [13 ]Royal Devon and Exeter Hospital, Exeter, United Kingdom
                [14 ]Universidad de la República, Hospital Maciel, Montevideo, Uruguay
                [15 ]Hokkaido University School of Medicine, Sapporo, Japan
                [16 ]Hôpital Cochin (Assistance Publique–Hôpitaux de Paris), University Paris Descartes, Paris, France
                [17 ]Thorax Institute, Hospital Clinic Universitat de Barcelona, Barcelona, Spain
                [18 ]St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
                [19 ]University of Manchester, Manchester, United Kingdom
                [20 ]University Hospital, Birmingham, United Kingdom; and
                [21 ]Hospital Clínic, Universitat de Barcelona, Centro de Investigación Biomédica en Red de Enfermedade Respiratorias, Barcelona, Spain
                Article
                10.1164/rccm.201701-0218PP
                28128970
                © 2017

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