Vestbo Jørgen, Hurd Suzanne S, Rodriguez-Roisin Roberto
Department of Respiratory Medicine J, Odense University Hospital, Odense, Denmark.
Clin Respir J. 2012 Oct;6(4):208-14. doi: 10.1111/crj.12002.
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published a strategy for diagnosis and for management of chronic obstructive pulmonary disease (COPD) since 2001 and this has formed the basis for numerous national and regional guidelines.
We describe the background for the 2011 revision of the GOLD document.
The GOLD document is updated annually and revised every 5 years based on published research as well as an evaluation by an expert panel of how to best formulate and disseminate knowledge on COPD.
The GOLD 2011 revision states that spirometry is required for making a clinical diagnosis of COPD. At the same time, the document has less emphasis on spirometric evaluation of disease severity and launches a combined assessment taking symptoms, spirometry and history of exacerbations into account. This is matched with initial treatment for COPD where smoking cessation, pulmonary rehabilitation and physical activity in general are given high priority followed by pharmacologic treatment guided by the novel assessment scheme. Comorbidities are often present in COPD and the GOLD 2011 revision gives some guidance in how to manage these as well as how to manage COPD in the presence of comorbidities.
A more clinically oriented GOLD document will hopefully improve assessment and management of COPD.
自2001年以来，慢性阻塞性肺疾病全球倡议组织（GOLD）发布了慢性阻塞性肺疾病（COPD）的诊断和管理策略，这已成为众多国家和地区指南的基础。
我们描述GOLD文件2011年修订版的背景。
GOLD文件每年更新，并根据已发表的研究以及专家小组对如何最佳制定和传播COPD知识的评估，每5年修订一次。
GOLD 2011修订版指出，临床诊断COPD需要进行肺功能测定。同时，该文件对疾病严重程度的肺功能评估的重视程度降低，并推出了一种综合评估方法，将症状、肺功能测定和急性加重史考虑在内。这与COPD的初始治疗相匹配，其中戒烟、肺康复和一般体育活动被高度优先考虑，随后是根据新的评估方案进行药物治疗。COPD患者常伴有合并症，GOLD 2011修订版对如何管理这些合并症以及在存在合并症的情况下如何管理COPD提供了一些指导。
一份更以临床为导向的GOLD文件有望改善COPD的评估和管理。
