The 2007 GOLD Guidelines: a comprehensive care framework.

Comprehensive management of chronic obstructive pulmonary disease (COPD) includes proper assessment, monitoring of disease, reduction of risk factors, the management of stable COPD, and the prevention and management of exacerbations. The 2007 COPD guidelines from the Global Initiative for Chronic Obstructive Lung Disease address each of these aspects of COPD management in detail and provide evidence-based recommendations for patients and health-care professionals. Reduction of risk factors emphasizes the importance of smoking cessation and control of environmental indoor and outdoor pollutants. The management of COPD must be individualized. Aerosol administration of bronchodilators is the most effective method of reducing the work of breathing and alleviating dyspnea. Glucocorticosteroid therapy is recommended to reduce the frequency of exacerbations and improve health-related quality of life for patients with stage 3 and 4 COPD. Pulmonary rehabilitation proves effective in relieving symptoms, improving quality of life, and increasing patients' physical and emotional participation in activities of daily life. Oxygen therapy is essential for patients with substantial hypoxia. Patients with COPD and respiratory failure may benefit from noninvasive ventilation. Surgery may play a limited role in the management of selected patients with COPD. Since exacerbations influence lung function and clinical decline in patients with COPD and contribute to the cost of caring for this disease, efforts must be directed at prevention and management of exacerbations. In addition to controlled oxygen therapy, antimicrobials, brief courses of systemic corticosteroids and, on occasion, noninvasive or invasive mechanical ventilation may play a role. The role of respiratory therapists in the prevention, diagnosis, and management of stable COPD and exacerbations is absolutely essential if the goals of the 2007 Global Initiative for Chronic Obstructive Lung Disease guidelines are to be attained.