COPD Gold Guidelines

Written by Joann Jovinelly and Christine Case-Lo | Published on September 22, 2014
Medically Reviewed by George T. Krucik, MD, MBA on September 22, 2014

What Is COPD?

Chronic obstructive pulmonary disease (COPD) is an umbrella term that includes a variety of progressively debilitating lung diseases. COPD includes both emphysema and chronic bronchitis.

Cigarette smoking causes most COPD around the world. Despite worldwide efforts by health professionals to raise awareness about smoking dangers, COPD remains widespread.

The World Health Organization estimates that COPD will rank as the world’s third-largest killer by 2030. In the United States, COPD is already the nation’s third-leading killer.

The National Institutes of Health expects the situation to become worse. COPD currently affects as many as 24 million American men and women. However, only half of them are even aware they have the disease.

Formation of the Global Initiative

In 1998, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) formed to promote COPD education and help set universal standards of treatment. GOLD tries to stem the tide of COPD cases and promote increased patient understanding. By 2001, GOLD filed its first report. Frequent revisions keep GOLD standards up to date.

The 2012 report advocated an individualized approach to COPD classification and treatment. The most recent update of the 2012 report was published in January 2014. 

The 2014 GOLD report includes updates rooted in evidence-based medicine. Recommendations integrate important study findings. The GOLD report doesn’t just ask whether a treatment improves lung function. GOLD questions whether an intervention improves patient outcomes or quality of life.

Dr. Roberto Rodriguez-Roisin is the chair of the GOLD Board of Directors. Dr. Jørgen Vestbo is Chair of the GOLD Science Committee. They explained that COPD patients shouldn’t be evaluated only by lung function tests. Considering of a variety of factors, such as day-to-day symptoms, leads to a more accurate COPD diagnosis.

“Spirometry is essential for diagnosis of COPD, but it doesn’t fully capture the impact of the disease on individual patients,” explained Vestbo. The 2012 GOLD guidelines draw attention to other factors. These include the severity of shortness of breath and the frequency of flare-ups. COPD patients must reduce flare-ups, which are typically caused by infection. Multiple, frequent exacerbations cause permanent loss of lung function.   

Revised GOLD Guidelines

The 2014 revision includes the latest standards for medication use. These impact widely used treatments, like corticosteroids (CSs), long-acting bronchodilators (BDs), and anticholinergics (ACs). The latest study results are reflected in recommended dosages and drug delivery methods. 

The 2014 revision also emphasized the increased risks of complications in COPD. For example, deep vein thrombosis and pulmonary embolism in hospitalized COPD patients can kill. GOLD also added an entire new section on Asthma and COPD Overlap Syndrome.

The 2014 revised GOLD guidelines build on those of 2012. As previously mentioned, the 2012 GOLD guidelines consider many factors besides breathing tests to determine COPD diagnosis. 

The GOLD treatment strategy is additive. New medications are added but not subtracted as the disease progresses. The 2012 guidelines also classify COPD in four stages according to its severity.

COPD Stage 1/Mild

Stage 1 COPD is considered mild and has few symptoms. Coughing is infrequent. Lung function tests reveal forced expiratory volume (FEV1) numbers at less than 80 percent of normal. Treatment for stage 1 is usually a short-acting bronchodilator. This is used as needed to open up restricted airways.      

COPD Stage 2/Moderate

Stage 2 COPD is considered moderate. Shortness of breath while exercising is common. Stage 2 COPD  treatment includes a short-acting bronchodilator. In addition, GOLD recommends one or more long-acting bronchodilator medications. 

Patients with moderate COPD benefit from exercise. Pulmonary rehabilitation helps maintain lung function. Stage 2 FEV1 numbers reflect between 50 and 79 percent of normal lung function.   

COPD Stage 3/Severe

Stage 3 COPD patients have increased shortness of breath. Treatment includes one or more BDs and pulmonary rehabilitation. Doctors will often add inhaled CSs for periods of worsened symptoms. GOLD recommends vaccination for pneumonia and seasonal influenza. Lung function tests show between 30 and 49 percent of normal function.         

COPD Stage 4/Very Severe

Stage 4 COPD reflects severe lung damage. Symptoms worsen, and coughing and mucus production increase. Any activity is a challenge. People with stage 4 COPD rely on oxygen therapy. Flare-ups are increasingly serious, even possibly deadly. 

Treatment includes a variety of BDs and inhaled CSs, oxygen therapy, vaccinations, and antibiotics. Doctors may also recommend surgery to remove damaged lung tissue. Stage 4 lung function is less than 30 percent of normal.

Summary

The GOLD guidelines reflect universal standards in diagnosis and treatment. The ultimate GOLD mission is to increase awareness of COPD. Proper diagnosis and treatment increases the lifespan and quality of life in COPD patients. In general, COPD is a very complex disease. Other factors can also both positively and adversely affect lung function. To improve your lung function, consider remedying these possible issues:

  • obesity
  • co-morbidities like heart disease and high blood pressure
  • continued smoking
  • history of immobility
  • ongoing exposure to pollution or other irritants 
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