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

Abstract

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.

Keywords

Affiliated Institutions

• Brigham and Women's Hospital US
• Hôpital Cochin FR
• Royal Devon and Exeter Hospital GB
• New York Hospital Queens US
• Université Paris Cité FR
• NewYork–Presbyterian Hospital US
• Assistance Publique – Hôpitaux de Paris FR
• Temple University US
• Universidad de Montevideo UY
• University of Manchester GB
• Universidad de la República de Uruguay UY
• The University of Texas Health Science Center at San Antonio US
• NIHR Surgical Reconstruction and Microbiology Research Centre GB
• University of Michigan US
• McGill University Health Centre CA
• Central University of Venezuela VE
• Presbyterian Hospital US
• University of British Columbia CA
• Universitat de Barcelona ES
• Cornell University US
• Flinders University AU
• Oxford BioMedica (United Kingdom) GB
• University of Ferrara IT
• German Center for Lung Research DE

Related Publications