Practically significant innovations in GOLD 2011 guidelines for diagnosis, management and prevention of chronic obstructive pulmonary disease

Abstract

One of actual practical and scientific problems in general medicine and especially pulmonology is development of chronic obstructive pulmonary disease (COPD). Aim of the investigation was to reveal practically significant innovations in Global Initiative for chronic Obstructive Lung Disease (GOLD) 2011 guidelines for diagnosis, management and prevention of COPD. Material and methods: Comparation of two versions of GOLD guidelines published on official website www.goldcopd.org dated December, 2010 and February, 2012 (last one launched during a symposium hosted by the Asian Pacific Society of Respirology in November 2011) was performed. Only practically significant introductions are represented in this report. Results. The definition of COPD was reworded: 1) “common” - really, during last few years the incidence of COPD increased greatly all over the world; 2) “persistent” (about airflow limitation), while in all previous versions (starting from 2001) more cautious formulation “not fully reversible” was used. Additionally an assured formulation “exacerbations and comorbidities contribute to the overal severity of individual patients” is stated, while previously exacerbations were not included in COPD definition at all, and only presumptive “extrapulmonary effects may contribute” was used instead. Individualization of medical approach to patients with COPD remains in the limelight of COPD definition. Vitally important changes were conducted in diagnosis and assessment of COPD. It is still based on the patient's symptoms, the severity of the spirometric abnormality, identification of comorbidities, while evaluation of future risk of exacerbations was dramatically changed. Significance of lung ventilation function is specially highlighted: “Whereas spirometry was previously used to support a diagnosis of COPD, spirometry is now required to make a confident diagnosis of COPD”. Modernization of COPD management was performed using new diagnosis and assessment approaches to COPD. Strategy considering both disease impact (determined mainly by symptom burden and activity limitation) and future risk of disease progression (especially of the exacerbations) is recommended. Conclusion. New GOLD 2011 guidelines reflect a big step forward made in modern conception of COPD diagnosis, management and prevention. Further perspective from our point of view is to publish comprehensive monographs on the matter under the aegis of GOLD because of perfect analysis methodology provided by this international institution and highest qualification of experts (national leaders from different countries allover the world). This would greatly help medical practitioners and researchers.