Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019.

Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary. / Informe 2017 de la Iniciativa Global para el Diagnóstico, Tratamiento y Prevención de la Enfermedad Pulmonar Obstructiva Crónica: Resumen Ejecutivo de GOLD.

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

Informe 2017 de la Iniciativa Global para el Diagnóstico, Tratamiento y Prevención de la Enfermedad Pulmonar Obstructiva Crónica: resumen ejecutivo de GOLD / Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD executive summary

Este resumen ejecutivo del Informe de 2017 de la Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) se basa principalmente en las modificaciones y novedades del documento anterior. Los cambios más destacados incluyen: a) se ha diferenciado entre la exploración espirométrica y la de los síntomas para evaluar la enfermedad pulmonar obstructiva crónica (EPOC). En la propuesta actual, los grupos ABCD se refieren exclusivamente a síntomas y antecedentes de exacerbaciones de los pacientes; b) para cada uno de los grupos, se proponen estrategias de intensificación de los tratamientos farmacológicos; c) se introduce el concepto de reducción escalonada de la terapia en el esquema de evaluación del tratamiento; d) se detalla más extensamente el tratamiento no farmacológico; y, f) se revisa la importancia de las diferentes co-morbilidades en lo que respecta al tratamiento de la EPOC

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed

Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

This Executive Summary of the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: (i) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary.

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.

Bronquitis crónica y enfisema: antiguas y modernas terapéuticas / Chronic bronchitis and emphysema: ancient and modern therapies

Los enfermos portadores de Bronquitis Crónica y Enfisema, integrantes del complejo EPOC se caracterizan por su cronicidad, frecuentes descompensaciones y deterioro funcional, progresivo y representan una amenaza de desánimo para los médicos. Sin embargo existen modernas medidas terapéuticas que asociadas a las clásicas, permiten avizorar un futuro mejor para nuestros pacientes. En este artículo se resumen los fundamentos patogénicos de la enfermedad y se revisan los esquemas de tratamiento farmacológico actualmente utilizados. Luego se exponen los avances terapéuticos que implican la oxigenoterapia prolongada, los programas de rehabilitación y las propuestas de cirugía de remodelación pulmonar con sus correspondientes respaldos de la investigación internacional sobre el tema. Se incluye la revisión de la experiencia de rehabilitación respiratoria del CASMU a dos años de su implementación