GOLD 2017: reviewing the latest recommendations

The Global Initiative for Obstructive Lung Disease (GOLD) guidelines are updated annually. The latest edition for 2017, contained some significant changes from previous publications. In this article we sum up some of those key changes.

The updated GOLD guidelines can be downloaded at www.goldcopd.org

Definition and diagnosis of COPD

In 2017 GOLD reviewed its definition of chronic obstructive pulmonary disease (COPD) to include greater consideration of the pathophysiological changes in airways and alveoli, the role of host factors (e.g. genetic influences, low birthweight and/or childhood respiratory illnesses) and the preventable causes including smoking.

The diagnostic features of COPD have also been reviewed. GOLD now recognises that chronic bronchitis (having a cough with sputum production that lasts for three months once a year for at least two years) and emphysema are not always part of how COPD presents. Instead, the guidelines advise that clinicians should suspect a diagnosis of COPD if a patient who has been exposed to risk factors for COPD reports progressive and persistent dyspnoea, chronic cough and persistent wheeze (expiratory and/or inspiratory) and chronic sputum production. Any family history of COPD increases the likelihood of the diagnosis, as does a personal history of low birthweight or lung infections in childhood.