Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) issued its first report in 2001. Much has been learned since the release of the first guidelines, and an updated guide was released in 2011 (http://www.copd.org/resources/clinician). The treatment of COPD now centers on the relief and reduction of symptoms as well as reduction of the risk of future adverse health events (eg, exacerbations). The update emphasizes the importance of these treatment strategies and provides significant updates in the field.
There are several key points emphasized in the guidelines. COPD is a common preventable and treatable disease. Exacerbations and comorbidities contribute to the overall severity in individual patients. Worldwide, the most commonly encountered risk factor for COPD is tobacco smoking. A clinical diagnosis should be considered in any patient who has dyspnea, chronic cough or sputum production, and a history of exposure to an appropriate risk factor. Appropriate pharmacologic and nonpharmacologic (eg, pulmonary rehabilitation) therapies are effective in the overall treatment strategy.
The most significant update with this newly released guide involves the recommendations surrounding the assessment of an individual patient with COPD. Formerly, the assessment of an individual with COPD involved a determination of the degree of airflow obstruction by spirometry. The new classification involves not only this spirometric assessment but also the assessment of the patient's symptoms and the risk of exacerbations. In order to more completely assess a patient's symptoms, validated questionnaires such as the COPD Assessment Test (CAT) or the Modified British Medical Research Count (mMRC) breathlessness scale should be used. In order to complete the assessment process, determination of the number of exacerbations a patient has had during the preceding year should be performed.
Each of these three measures (spriometry, symptoms and exacerbation risk) is combined into a single patient group (defined as Groups A to D). Recommendations are then made for each group regarding the appropriate pharmacologic therapy (including bronchodilators, corticosteroids, phosphodiesterase-4 inhibitors, methylxanthines, vaccines, alpha-1-antitrypsin replacement and antibiotics) and nonpharmacologic therapy (including rehabilitation, supplemental oxygen, ventilatory support and surgery).
This newly designed assessment strategy integrates the key components for an individual patient with COPD: airflow limitation, symptoms and risk of exacerbations. An overall assessment of an individual patient can help to develop an appropriate and effective treatment strategy that will help to reduce the morbidity associated with the illness. Further information on the recently released GOLD report can be found at www.goldcopd.org.