Global Initiative for Chronic Obstructive Lung Disease
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to raise awareness of Chronic Obstructive Pulmonary Disease (COPD) and to improve prevention and treatment of this lung disease.
The GOLD initiative gives out guidelines for COPD Diagnosis, Management, and Prevention.
GOLD guidelines indicate that spirometry is of the utmost importance in diagnosing COPD.
GOLD Classification for COPD
For many years GOLD classification was based only on lung function parameters.
|GOLD 1: Mild COPD|| FEV1/FVC < 70%
FEV1 > or equal to 80% predicted
|GOLD 2: Moderate COPD||FEV1/FVC < 70%
FEV1 between 50 and 80% predicted
|GOLD 3: Severe COPD||FEV1/FVC < 70%
FEV1 between 30 and 50% predicted
|GOLD 4: Very Severe COPD||FEV1/FVC < 70%
FEV1 < or equal to 30% predicted
GOLD Classification for symptom severity
In 2013 the GOLD initiative published a new classification for COPD severity. Where the older versions only took lung values in account, GOLD 2013 also takes severity of symptoms and number of exacerbations into account. Aside from the classic GOLD 1, 2, 3 and 4 stages, the new classification distinguishes also stages A, B, C and D.
Symptom severity is assessed using the mMRC scale (modified Medical Research Council Dyspnea scale) or the CAT questionnaire (COPD Assessment Test).
The new GOLD classification is as follows:
|GOLD class||4||C||D||>1||Exacerbation history|
The GOLD classification uses risk factors (GOLD 1 to 4 and number of exacerbations) and symptom severity (mMRC or CAT scale). In case both risk factors would fall in a different category, the highest risk factor is used (eg: GOLD 1 (GOLD A or B) with 2 COPD exacerbations last year (GOLD C or D) would be GOLD C or GOLD D).
GOLD A and B are low risk, GOLD C and D are high risk patients.
GOLD A and C have few symptoms, GOLD B and D have more symptoms.
GOLD Therapy Guidelines
The new GOLD 2013 treatment plan is based on reduction of symptoms and reduction of risks.
|patient group||first choice treatment||alternative treatment||other possible treatments|
|SABA = short-acting beta2-agonist|
SAAC = short-acting anticholinergic
LABA =long-acting beta2-agonist
LAAC = long-acting anticholinergic
ICS = Inhaled corticosteroid
PDE4I = phosphodiesterase-4 inhibitor
|A||when necessary: SAAC |
SAAC + SABA
|LAAC + LABA||SABA and/or SAAC|
|C||ICS + LAAC |
|LAAC + LABA |
LAAC + PDE4I
LABA + PDE4I
|SABA and/or SAAC|
|D||ICS + LAAC|
|ICS + LABA + LAAC|
ICS + LABA + PDE4I
LAAC + LABA
LAAC + PDE4I
SABA and/or SAAC
The official guidelines can be downloaded from the GOLD website.
Many patients believe that once damage has been done, smoking cessation isn't necessary anymore.
The Fletcher-Peto graph clearly shows the importance to quit smoking, even if serious damage is already present.
Fletcher's graph clearly shows the importance of smoking cessation, even in late stage COPD