Global strategy for the diagnosis, management, and ...



Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease.

BIBLIOGRAPHIC SOURCE(S)

• Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis , management, and prevention of chronic obstructive pulmonary disease. Bethesda (MD): Global Initiative for Chronic Obstructive Lung Disease (GOLD); 2008. 94 p. [435 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Bethesda (MD): Global Initiative for Chronic Obstructive Lung Disease, World Health Organization, National Heart, Lung and Blood Institute; 2007. [420 references]

MAJOR RECOMMENDATIONS

The levels of evidence (A-D) are defined at the end of the "Major Recommendations" field.

Definition

|Key Points |

|Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with some significant extrapulmonary effects that may contribute to|

|the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow |

|limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. |

|The chronic airflow limitation characteristic of COPD is caused by a mixture of small airway disease (obstructive bronchiolitis) and parenchymal |

|destruction (emphysema), the relative contributions of which vary from person to person. |

|COPD has a variable natural history and not all individuals follow the same course. However, COPD is generally a progressive disease, especially if a |

|patient's exposure to noxious agents continues. |

|The impact of COPD on an individual patient depends on the severity of symptoms (especially breathlessness and decreased exercise capacity), systemic |

|effects, and any comorbidities the patient may have—not just on the degree of airflow limitation. |

COPD and Comorbidities

COPD should be managed with careful attention also paid to comorbidities and their effect on the patient's quality of life. A careful differential diagnosis and comprehensive assessment of severity of comorbid conditions should be performed in every patient with chronic airflow limitation.

Spirometric Classification of Severity

For educational reasons, a simple spirometric classification of disease severity into four stages is recommended. Spirometry is essential for diagnosis and provides a useful description of the severity of pathological changes in COPD.

Spirometry should be performed after the administration of an adequate dose of an inhaled bronchodilator (e.g., 400 micrograms salbutamol) in order to minimize variability.

|Figure 1:Spirometric Classification of COPD Severity Based on Post-Bronchodilators FEV1 |

|Stage I: Mild |FEV1/FVC 80% predicted |

|Stage II: Moderate |FEV1/FVC ................
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