Köktürk Nurdan, Gürgün Alev, Şen Elif, Kocabaş Ali, Polatlı Mehmet, Naycı Sibel Atış, Çöplü Lütfi, Tellioğlu Emel, Elmas Funda, Erdinç Ertürk
Department of Pulmonary Medicine, Gazi University School of Medicine, Ankara, Turkey.
Department of Pulmonary Medicine, Ege University School of Medicine, İzmir, Turkey.
Turk Thorac J. 2017 Apr;18(2):57-64. doi: 10.5152/TurkThoracJ.2017.060417. Epub 2017 Apr 1.
Since the Global Initiative for Obstructive Lung Disease (GOLD) published its first guidelines on chronic obstructive pulmonary disease (COPD) in 2001, much has changed till 2017. Previous versions of GOLD guidelines mentioned the forced expiratory volume in one second (FEV)-based approach for staging and treatment modalities. Since 2011, a composite multi-dimensional approach has been introduced to cover various aspects of the disease. Unfortunately, this approach was not found to be correlated with mortality as well as the FEV-based approach, despite the fact that it was better for estimating exacerbation rates. Although this assessment tool has been considered as a big step in personalized medicine, the system was rather complex to use in daily practice. In 2017, GOLD introduced a major revision in many aspects of the disease. This mainly includes a revised assessment tool and treatment algorithm. This new ABCD algorithm has excluded spirometry for guiding pharmacological therapy. Treatment recommendations are mainly based on symptoms and exacerbation rates. Escalation and de-escalation strategies have been proposed for the first time. The spirometric measurement has only been retained to confirm the diagnosis and lead to nonpharmacological therapies. In this report, the Turkish Thoracic Society COPD assembly aimed to summarize and give an insight to the Turkish interpretation of GOLD 2017.
自慢性阻塞性肺疾病全球倡议组织（GOLD）于2001年发布首版慢性阻塞性肺疾病（COPD）指南以来，至2017年已有诸多变化。GOLD指南的以往版本提及基于一秒用力呼气容积（FEV）的分期及治疗方式。自2011年起，引入了一种综合多维度方法以涵盖该疾病的各个方面。遗憾的是，尽管该方法在估计急性加重率方面表现更佳，但并未发现其与死亡率的相关性如同基于FEV的方法那样紧密。尽管该评估工具被视为个性化医疗的一大进步，但其在日常实践中使用起来相当复杂。2017年，GOLD在该疾病的诸多方面进行了重大修订。这主要包括修订后的评估工具和治疗算法。这种新的ABCD算法不再将肺功能测定用于指导药物治疗。治疗建议主要基于症状和急性加重率。首次提出了升级和降级策略。肺功能测定仅保留用于确诊及指导非药物治疗。在本报告中，土耳其胸科学会COPD委员会旨在总结并深入介绍土耳其对GOLD 2017的解读。
