GOLD 2011 Guidelines — New Assessment System to Guide Therapy of COPD Patients

This approach focuses on symptom control and risk for adverse events in patients with chronic obstructive pulmonary disease.

The second 5-year update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) consensus report is available. Although not dramatically different from earlier versions, it includes a new assessment and grading system to guide treatment of patients with stable chronic obstructive pulmonary disease (COPD). This approach deemphasizes using forced expiratory volume in 1 second (FEV1) alone to stage disease and focuses instead on both symptom control and risk for adverse events. The change is based on a growing body of literature which demonstrates that FEV1 does not correlate well with individual patients' severity of dyspnea, exercise limitations, or health status.

The GOLD recommendations can be downloaded as a pocket guide. To classify patients, the following steps are required:

• Determine risk, using either FEV1 or frequency of exacerbations.
• Assess symptoms, using either the Modified British Medical Research Council questionnaire on breathlessness or the COPD Assessment Test.
• Assign the patient to one of four severity groups, based on risk and symptoms.

Treatment recommendations are provided for each of the four groups. Inhaled steroids are reserved for patients with either 2 exacerbations annually or FEV1 <50% of predicted.

CITATION(S):

Vestbo J et al. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2012 Aug 9; [e-pub ahead of print].

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