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Practical Pearls from the GOLD Guidelines on COPD

By Juan Garcia, MD, FCCP; and Stephen Jenkinson, MD, FCCP

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Objectives
  1. Be familiar with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines.
  2. Know that objective measurement of pulmonary function is essential for the diagnosis and assessment of COPD.
  3. Review the medical therapy indicated for treatment of stable COPD and COPD exacerbations, and the medical therapy that is not indicated for treatment of COPD.
  4. Emphasize importance and indications of home oxygen therapy in COPD patients.
  5. Know the importance of noninvasive mechanical ventilation in treating patients with COPD exacerbations.
Key words

anticholinergics; bronchodilators; chronic bronchitis; COPD; COPD exacerbations; emphysema; inhaled corticosteroids; oxygen therapy; smoking; smoking cessation; spirometry

Abbreviations

AAT = a1-antitrypsin; GOLD = Global Initiative for Chronic Obstructive Lung Disease; NIPPV = noninvasive positive pressure ventilation

In late 2001, under the direction of the National Heart, Lung and Blood Institute and the World Health Organization, an expert panel released a set of new guidelines on the diagnosis and management of COPD, entitled the Global Initiative for Chronic Obstructive Lung Disease (GOLD).1 The document presents an evidence-based approach to managing COPD. These guidelines define the classifications of COPD on the basis of both severity and type of symptoms, and explore all new information on the diagnosis and treatment of COPD. We will divide the report into a series of categories and discuss the clinical implications of the various components of the GOLD document. We have also added some pearls that are the result of new data in COPD patients published after the GOLD guidelines were finished.

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