Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD Science Committee Report 2019
File(s)
Accepted version
Author(s)
Type
Journal Article
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 (ICS) in 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 the management of chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment naïve 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 ICS 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 paper explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.
Date Issued
2019-05-18
Date Acceptance
2019-03-01
Citation
European Respiratory Journal, 2019, 53 (5)
ISSN
0903-1936
Publisher
European Respiratory Society
Journal / Book Title
European Respiratory Journal
Volume
53
Issue
5
Copyright Statement
© ERS 2019. This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication.
Sponsor
Medical Research Council (MRC)
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30846476
PII: 13993003.00164-2019
Grant Number
G1001372
Subjects
Science & Technology
Life Sciences & Biomedicine
Respiratory System
BLOOD EOSINOPHIL COUNT
SHORT-TERM RESPONSE
POST-HOC ANALYSIS
PULMONARY-DISEASE
SPUTUM-EOSINOPHILIA
COPD
EXACERBATIONS
STABILITY
INFLAMMATION
FLUTICASONE
11 Medical and Health Sciences
Respiratory System
Publication Status
Published
Coverage Spatial
England
Article Number
ARTN 1900164
Date Publish Online
2019-03-07