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: (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 de-escalation 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.

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Reduced lung-cancer mortality with low-dose computed tomographic screening.

(2011)

The aggressive and heterogeneous nature of lung cancer has thwarted efforts to reduce mortality from this cancer through the use of screening. The advent of low-dose helical computed tomography (CT) altered the landscape of lung-cancer screening, with studies indicating that low-dose CT detects many tumors at early stages. The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009. The rate of adherence to screening was more than 90%. The rate of positive screening tests was 24.2% with low-dose CT and 6.9% with radiography over all three rounds. A total of 96.4% of the positive screening results in the low-dose CT group and 94.5% in the radiography group were false positive results. The incidence of lung cancer was 645 cases per 100,000 person-years (1060 cancers) in the low-dose CT group, as compared with 572 cases per 100,000 person-years (941 cancers) in the radiography group (rate ratio, 1.13; 95% confidence interval [CI], 1.03 to 1.23). There were 247 deaths from lung cancer per 100,000 person-years in the low-dose CT group and 309 deaths per 100,000 person-years in the radiography group, representing a relative reduction in mortality from lung cancer with low-dose CT screening of 20.0% (95% CI, 6.8 to 26.7; P=0.004). The rate of death from any cause was reduced in the low-dose CT group, as compared with the radiography group, by 6.7% (95% CI, 1.2 to 13.6; P=0.02). Screening with the use of low-dose CT reduces mortality from lung cancer. (Funded by the National Cancer Institute; National Lung Screening Trial ClinicalTrials.gov number, NCT00047385.).

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Susceptibility to exacerbation in chronic obstructive pulmonary disease.

John R. Hurst, Jørgen Vestbo, Antonio Anzueto … (2010)

Although we know that exacerbations are key events in chronic obstructive pulmonary disease (COPD), our understanding of their frequency, determinants, and effects is incomplete. In a large observational cohort, we tested the hypothesis that there is a frequent-exacerbation phenotype of COPD that is independent of disease severity. We analyzed the frequency and associations of exacerbation in 2138 patients enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study. Exacerbations were defined as events that led a care provider to prescribe antibiotics or corticosteroids (or both) or that led to hospitalization (severe exacerbations). Exacerbation frequency was observed over a period of 3 years. Exacerbations became more frequent (and more severe) as the severity of COPD increased; exacerbation rates in the first year of follow-up were 0.85 per person for patients with stage 2 COPD (with stage defined in accordance with Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages), 1.34 for patients with stage 3, and 2.00 for patients with stage 4. Overall, 22% of patients with stage 2 disease, 33% with stage 3, and 47% with stage 4 had frequent exacerbations (two or more in the first year of follow-up). The single best predictor of exacerbations, across all GOLD stages, was a history of exacerbations. The frequent-exacerbation phenotype appeared to be relatively stable over a period of 3 years and could be predicted on the basis of the patient's recall of previous treated events. In addition to its association with more severe disease and prior exacerbations, the phenotype was independently associated with a history of gastroesophageal reflux or heartburn, poorer quality of life, and elevated white-cell count. Although exacerbations become more frequent and more severe as COPD progresses, the rate at which they occur appears to reflect an independent susceptibility phenotype. This has implications for the targeting of exacerbation-prevention strategies across the spectrum of disease severity. (Funded by GlaxoSmithKline; ClinicalTrials.gov number, NCT00292552.)

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An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

Martijn Spruit, Sally J Singh, Chris Garvey … (2013)

Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.

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Author and article information

Journal

Title: Respirology

Abbreviated Title: Respirology

Publisher: Wiley

ISSN: 13237799

Publication date Created: April 2017

Publication date (Print): April 2017

Publication date (Electronic): March 07 2017

Volume: 22

Issue: 3

Pages: 575-601

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

[21 ]Hospital Clínic; Universitat de Barcelona; Centro de Investigación Biomé dica en Red de Enfermedade Respiratorias Barcelona Spain

Article

DOI: 10.1111/resp.13012

PubMed ID: 28150362

SO-VID: 52b781df-9178-4278-8cd3-2ff27166dfbb

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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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Most cited references 333

Reduced lung-cancer mortality with low-dose computed tomographic screening.

Susceptibility to exacerbation in chronic obstructive pulmonary disease.

An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation.

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Affiliations

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