Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: GOLD Executive Summary

Respiratory Research Group, Manchester Academic Sciences Health Centre, Manchester, United Kingdom.
American Journal of Respiratory and Critical Care Medicine (Impact Factor: 13). 08/2012; 187(4). DOI: 10.1164/rccm.201204-0596PP
Source: PubMed


Chronic obstructive pulmonary disease (COPD) is a global health problem and since 2001 the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published its strategy document for the diagnosis and management of COPD. This executive summary presents the main contents of the second 5-year revision of the GOLD document that has implemented some of the vast knowledge about COPD accumulated over the last years. Today, GOLD recommends that spirometry is required for the clinical diagnosis of COPD in order to avoid misdiagnosis and to ensure proper evaluation of severity of airflow limitation. The document highlights that the assessment of the COPD patient should always include assessment of 1) symptoms, 2) severity of airflow limitation, 3) history of exacerbations, and 4) comorbidities. The first three points can be used to evaluate level of symptoms and risk of future exacerbations and this is done in a way that split COPD patients into 4 categories - A, B, C and D. Non-pharmacologic and pharmacologic management of COPD match this assessment in an evidence-based attempt to relieve symptoms and reduce risk of exacerbations. Identification and treatment of comorbidities must have high priority and a separate chapter in the document addresses management of comorbidities as well as COPD in the presence of comorbidities. The revised document also contains a new chapter on exacerbations of COPD. The GOLD initiative will continue to bring COPD to the attention of all relevant shareholders and will hopefully inspire future national and local guidelines on the management of COPD.

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Available from: Robert Rodríguez-Roisin, Oct 29, 2015
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    • "Previous studies have demonstrated that chronic inflammation and varying degrees of emphysematous alveolar destruction are the key pathological features of the disease (Stockley et al., 2009). Some studies have revealed that an imbalance of endogenous proteinases and antiproteinases, inflammatory cells, proinflammatory mediators, and oxidative stress were responsible for the pathogenesis of COPD (Vestbo et al., 2013). Genetic factors and environmental exposures like tobacco smoke are also involved in the pathogenesis of COPD (Restrepo, 2015). "
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    ABSTRACT: Introduction: Previous studies have shown that glutathione S-transferase P1 (GSTP1) was associated with chronic obstructive pulmonary disease (COPD). However, the association between GSTP1 Ile (105) Val gene polymorphism and COPD remains controversial. To drive a more precise estimation, we performed a meta-analysis based on published case-control studies. Methods: An electronic search of PubMed, EMBASE, Cochrane library, Web of Science and China Knowledge Resource Integrated (CNKI) Database for papers on GSTP1 Ile (105) Val gene polymorphism and COPD risk was performed. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were used to assess the strength of association in the homozygote model, heterozygote model, dominant model, recessive model and an additive mode. Statistical heterogeneity, test of publication bias and sensitivity analysis was performed. The software STATA (Version 13.0) was used data analysis. Results: Overall, seventeen studies with 1892 cases and 2012 controls were included in this meta-analysis. The GSTP1 Ile (105) Val polymorphism showed pooled odds ratios for the homozygote comparison (OR = 1.501, 95%CI [0.862, 2.614]), heterozygote comparison (OR = 0.924, 95%CI [0.733, 1.165]), dominant model (OR = 1.003, 95%CI [0.756, 1.331]), recessive model (OR = 1.510, 95%CI [0.934, 2.439]), and an additive model (OR = 1.072, 95%CI [0.822, 1.398]). Conclusions: In conclusion, the current meta-analysis, based on the most updated information, showed no significant association between GSTP1 Ile (105) Val gene polymorphism and COPD risk in any genetic models. The results of subgroup analysis also showed no significant association between GSTP1 Ile (105) Val gene polymorphism and COPD risk in Asian population and Caucasian population. Further studies involving large populations and careful control with age, sex, ethnicity, and cigarette smoking are greatly needed.
    Meta Gene 12/2015; 6:59-64. DOI:10.1016/j.mgene.2015.08.007
    • "We specifically postulated that, compared with age-and gender-matched COPD, overlap patients would present with reduced CBF thereby leading to lower COx. Methods Subjects Eighteen sedentary males with well-established moderate-to-severe COPD (Global Initiative for Obstructive Lung Disease stages 2 and 3)(Vestbo et al., 2013) comprised the study group. Eight patients had echocardiographic evidences of heart failure with reduced left ventricular ejection fraction (<50%). "
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    ABSTRACT: Cerebral blood flow (CBF) and oxygenation (COx) are generally well-preserved in COPD. It is unknown whether prevalent cardiovascular co-morbidities, such as heart failure, may impair CBF and COx responses to exertion. Eighteen males with moderate-to-severe COPD (8 with and 10 without overlapping heart failure) underwent a progressive exercise test with pre-frontal CBF and COx measurements (indocyanine green and near-infrared spectroscopy). Mean arterial pressure and cardiac output were lower from rest to exercise in overlap. Only COPD patients demonstrated an increase in arterialized PCO2 towards the end of progressive exercise. CBF index was consistently higher and increased further by ∼40% during exercise in COPD whereas a ∼10% reduction was observed in overlap. COx was lower in overlap despite preserved arterial oxygenation. In conclusion, heart failure introduces pronounced negative effects on CBF and COx in COPD which may be associated with clinically relevant outcomes, including dyspnea, exercise intolerance, cerebrovascular disease and cognition.
    Respiratory Physiology & Neurobiology 11/2015; DOI:10.1016/j.resp.2015.10.005 · 1.97 Impact Factor
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    • "Chronic obstructive pulmonary disease (COPD) is an important disease with high prevalence worldwide and in China (Buist et al., 2007; Zhong et al., 2007), and it will become the third leading cause of death worldwide by 2020 (Vestbo et al., 2013). Lung function is a golden standard for COPD diagnosis and its reduction plays an important role in COPD development and exacerbation (Vestbo et al., 2013). The natural history of COPD is defined by a progressive decline in lung function leading to earlier and/or larger deficits than normal aging (Schikowski et al., 2014). "
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    ABSTRACT: BACKGROUND: The use of ambient air pollution data obtained from central air-monitoring stations as surrogates for participants' exposures to outdoor air pollutants in previous studies may have introduced bias in the estimation of exposure-response associations. OBJECTIVES: We investigated and compared the effects of short-term exposure to outdoor particulate matter (PMout) and outdoor-originated equivalent personal PM (PMeq) on lung function in chronic obstructive pulmonary disease (COPD) patients. METHODS: A total of 33 doctor-diagnosed stable COPD patients were recruited and repeatedly measured for lung function (totally 170 measurements) in 2013-2014. Daily PMout concentrations were obtained from central-monitoring stations, and daily time-weighted average PMeq concentrations were estimated based on PMout over the study. Associations of PM with lung function were estimated using mixed-effects models. RESULTS: Interquartile range increases in PM2.5out (111.0μg/m3, 5-day) and PM10out (112.0μg/m3, 3-day) were associated with a 3.3% (95% confidence interval [CI]: -5.8%, -0.8%) reduction and a 2.1% (95%CI: -3.9%, -0.3%) reduction in forced vital capacity (FVC), respectively. Similar results were found for forced expiratory volume in 1s (FEV1). An interquartile range increase in PM2.5eq (45.3μg/m3, 3-day), but not PM10eq, was still associated with a 1.7% (95%CI: -3.3%, -0.1%) reduction in FVC. CONCLUSIONS: Our study may provide a novel approach to assess the association of ambient PM with health observations with improved accuracy.
    Science of The Total Environment 10/2015; 542(Pt A):264-270. DOI:10.1016/j.scitotenv.2015.10.114 · 4.10 Impact Factor
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