![]() 15,16 Environmental pollution, temperature, and pulmonary embolism are also known exacerbation triggers. 3,15 The majority of exacerbations result from respiratory infections caused by virus (e.g., human rhinovirus) and bacteria (e.g., Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pnuemoniae, and Pseudomonas aeruginosa). 3 To establish an official diagnosis of COPD in a patient with risk factors and symptoms, a postbronchodilator FEV 1 to forced vital capacity (FVC) ratio (FEV 1/FVC) 0.34 x 10 9 cells/L) are also at increased risk for COPD exacerbations. 3,5Ī diagnosis of COPD, therefore, should be considered in patients with a prior history of risk-factor exposure, in addition to symptom development such as dyspnea, chronic cough, or sputum production. 3 The structural narrowing of the peripheral airways, in addition to the chronic inflammation, is directly related to the reduction in the volume of air exhaled at the end of the first second of forced expiration (FEV 1) typically seen in patients with COPD. Over time, chronic inflammation causes structural changes to the airway, resulting in progressive airflow limitation seen upon spirometry. 3 As the lungs are exposed to noxious particles or gases, they become inflamed. The degree of chronic airflow limitation is measured by spirometry and progresses at varying rates over time, differing from person to person. The management of COPD depends on the assessment of disease severity. 3 The World Health Organization projects that by the year 2030, COPD will be the third-leading cause of death worldwide owing to an increase in risk-factor exposure and the aging of the world’s population. 1-3 Tobacco smoke is one of the greatest risk factors for the development of COPD.Īside from tobacco smoke, exposure to noxious particles from the environment and various host factors, including genetics, age, and airway hyper-responsiveness, also influence disease development. The GOLD report defines COPD as a preventable disease characterized by progressive airflow limitation and persistent respiratory symptoms. Since 2001, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) has released guidelines to provide clinicians with the tools they need to properly and consistently diagnose, manage, and prevent COPD. Additionally, there were also modifications to the pharmacotherapy treatment algorithm and new recommendations for the prevention and management of acute COPD exacerbations. The updated GOLD report includes a simplified version of the ABCD assessment tool, which separates symptoms and exacerbation risk from the severity of airflow limitation. The GOLD guideline recently underwent a major revision in 2017, in addition to a minor revision in 2018, to account for new evidence surrounding the assessment of disease severity, as well as therapeutic recommendations for the management of COPD. The guideline incorporates evidence-based recommendations regarding the assessment of disease severity, choice of pharmacologic treatment, and strategies for the management and prevention of acute exacerbations. ABSTRACT: Healthcare professionals across the world utilize the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline to guide the diagnosis, management, and prevention of chronic obstructive pulmonary disease (COPD).
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