Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD Science Committee Report 2019

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Title: Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: The GOLD Science Committee Report 2019
Authors: Singh, D
Agusti, A
Anzueto, A
Barnes, PJ
Bourbeau, J
Celli, BR
Criner, GJ
Frith, P
Halpin, DMG
Han, M
López Varela, MV
Martinez, F
Montes de Oca, M
Papi, A
Pavord, ID
Roche, N
Sin, DD
Stockley, R
Vestbo, J
Wedzicha, JA
Vogelmeier, C
Item 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.
Issue Date: 18-May-2019
Date of Acceptance: 1-Mar-2019
DOI: 10.1183/13993003.00164-2019
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/Funder: Medical Research Council (MRC)
Funder's Grant Number: G1001372
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
11 Medical and Health Sciences
Respiratory System
Publication Status: Published
Conference Place: England
Embargo Date: 2020-09-07
Article Number: ARTN 1900164
Online Publication Date: 2019-03-07
Appears in Collections:National Heart and Lung Institute

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