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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, April 8, 2013

GOLD 2013

PulmCCM - Apr 05, 2013
The 2011 GOLD classification for COPD: Old GOLD vs. New GOLD Guidelines.
By Brett Ley MD.
"Ever had a COPD patient with an awful FEV1, yet who seems to be cruising along, doing fine for years? How about a COPD patient with a relatively preserved FEV1, yet always seems to be in your clinic or the hospital?
Of course you have. We (clinicians and researchers) have recognized that the clinical behavior of individual patients with COPD is much more complex than is determined by the degree of airflow obstruction alone (i.e. FEV1). Since the first GOLD guidelines were published in 2001 (and updated in 2007) much research has gone into more meaningfully “phenotyping” patients with COPD, not only to help predict future clinical course, but also to aid in individualizing therapies. The BODE index demonstrated nicely how the incorporation of other clinical factors, including symptoms and functional capacity, could refine the prediction of mortality in patients with COPD beyond FEV1 strata. Further, COPD exacerbations are now recognized both as a clinically important outcome for therapeutic interventions and as a strong predictor of subsequent exacerbations and mortality.
Therefore, the newest GOLD guidelines (the 2011 version), which consider symptoms and exacerbation history in addition tothe degree of airflow obstruction for classifying patients, are a welcome update and a potential advancement in the clinical care of patients with COPD. Whether this system proves to be an improvement upon the old system requires more research. Two recent studies (reviewed below) begin to clarify how the new GOLD system, applied to broad populations of COPD patients, reclassifies risk and further characterizes patients in a way that may have important management implications."