Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is the fourth leading cause of chronic morbidity and mortality in the United States, and is projected to rank fifth in 2020 in burden of disease worldwide, according to a study published by the World Bank/World Health Organization. Yet, COPD remains relatively unknown or ignored by the public as well as public health and government officials. In 1998, in an effort to bring more attention to COPD, its management, and its prevention, a committed group of scientists encouraged the U.S. National Heart, Lung, and Blood Institute and the World Health Organization to form the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Among the important objectives of GOLD are to increase awareness of COPD and to help the millions of people who suffer from this disease and die prematurely of it or its complications. The first step in the GOLD program was to prepare a consensus report, Global Strategy for the Diagnosis, Management, and Prevention of COPD, published in 2001. The present, newly revised document follows the same format as the original consensus report, but has been updated to reflect the many publications on COPD that have appeared. GOLD national leaders, a network of international experts, have initiated investigations of the causes and prevalence of COPD in their countries, and developed innovative approaches for the dissemination and implementation of COPD management guidelines. We appreciate the enormous amount of work the GOLD national leaders have done on behalf of their patients with COPD. Despite the achievements in the 5 years since the GOLD report was originally published, considerable additional work is ahead of us if we are to control this major public health problem. The GOLD initiative will continue to bring COPD to the attention of governments, public health officials, health care workers, and the general public, but a concerted effort by all involved in health care will be necessary.

https://www.who.int/respiratory/copd/GOLD_WR_06.pdf

Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary.

The Standards for the Diagnosis and Treatment of Patients with COPD document 2004 updates the position papers on chronic obstructive pulmonary disease (COPD) published by the American Thoracic Society (ATS) and the European Respiratory Society (ERS) in 1995 1, 2. Both societies felt the need to update the previous documents due to the following. 1) The prevalence and overall importance of COPD as a health problem is increasing. 2) There have been enough advances in the field to require an update, especially adapted to the particular needs of the ATS/ERS constituency. 3) It allows for the creation of a “live” modular document based on the web; it should provide healthcare professionals and patients with a user friendly and reliable authoritative source of information. 4) The care of COPD should be comprehensive, is often multidisciplinary and rapidly changing. 5) Both the ATS and the ERS acknowledge the recent dissemination of the Global Initiative of Obstructive Lung Disease (GOLD) 3 as a major worldwide contribution to the battle against COPD. However, some specific requirements of the members of both societies require adaptation of the broad GOLD initiative. Those requirements include specific recommendations on oxygen therapy, pulmonary rehabilitation, noninvasive ventilation, surgery in and for COPD, sleep, air travel, and end-of-life. In addition, special emphasis has been placed on issues related to the habit of smoking and its control.

### Goals and objectives

The main goals of the updated document are to improve the quality of care provided to patients with COPD and to develop the project using a disease-oriented approach. To achieve these goals, both organisations have developed a modular electronic web-based document with two components. 1) A component for health professionals that intends to: raise awareness of COPD; inform on the latest advances in the overall pathogenesis, diagnosis, monitoring and management of COPD; and …

https://erj.ersjournals.com/content/erj/23/6/932.full.pdf

Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper

SUMMARY OF APPROACH The approach to surgery in the patient with COPD is summa-rized below. Surgery Definitely indicated Lung resection. Pulmonary function studies should be performedbefore lung resection. Simple spirometry has the greatest utilityin documenting physiologic operability. FEV, > 2 L in an adultman or > 60% of predicted is acceptable for pneumonectomy.Values below this suggest that further studies, such as split func-tion assessment by quantitative lung scintigraphy and exercisetesting, are warranted.FEV, predicted after lung resection to be less than 40 to 50%of normal for the patient’s sex, age, and height suggests highermorbidity and mortality. An exercise 90, of less than 10 to 15ml/min per kg of body weight is associated with higher mor-bidity and mortality after lung resection.All elective surgery Prophylaxis against deep venous throm-bosis should be given before most procedures that will requirepostoperative bed rest or significantly reduce mobility. Heparinin low doses seems well accepted for most procedures. Externalpneumatic compression of the lower legs can be used when anti-coagulants are contraindicated.

/pdf/standards-for-the-diagnosis-and-care-of-patients-with-13vz6fyao0.pdf

Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease

Representatives from many countries serve as a network for the dissemination and implementation of programs for diagnosis, management, and prevention of COPD. The GOLD Board of Directors is grateful to the many GOLD National Leaders who participated in discussions of concepts that appear in GOLD reports.

Global initiative for chronic obstructive lung disease.

Exacerbations occur commonly in patients with moderate or severe chronic obstructive pulmonary disease (COPD) but factors affecting their severity and frequency or effects on quality of life are unknown. We measured daily peak expiratory flow rate (PEFR) and daily respiratory symptoms for 1 yr in 70 COPD patients (52 male, 18 female, mean age [+/- SD] 67.5 +/- 8.3 yr, FEV1 1.06 +/- 0.45 L, FVC 2.48 +/- 0.82 L, FEV1/FVC 44 +/- 15%, FEV1 reversibility 6.7 +/- 9.1%, PaO2 8.8 +/- 1.1 kPa). Quality of life was measured by the St. George's Respiratory Questionnaire (SGRQ). Exacerbations (E) were assessed at acute visit (reported exacerbation) or from diary card data each month (unreported exacerbation). In 61 (87%) patients there were 190 exacerbations (median 3; range, 1 to 8) of which 93 (51%) were reported. There were no differences in major symptoms (increase in dyspnea, sputum volume, or purulence) or physiological parameters between reported and unreported exacerbations. At exacerbation, median peak flow fell by an average of 6.6 L/min (p = 0.0003). Using the median number of exacerbations as the cutoff point, patients were classified as infrequent exacerbators (E = 0 to 2) or frequent exacerbators (E = 3 to 8). The SGRQ Total and component scores were significantly worse in the group that had frequent exacerbations: SGRQ Total score (mean difference = 14.8, p < 0.001), Symptoms (23.1, p < 0.001), Activities (12.2, p = 0.003), Impacts (13.9, p = 0.002). However there was no difference between frequent and infrequent exacerbators in the fall in peak flow at exacerbation. Factors predictive of frequent exacerbations were daily cough (p = 0.018), daily wheeze (p = 0.011), and daily cough and sputum (p = 0.009) and frequent exacerbations in the previous year (p = 0.001). These findings suggest that patient quality of life is related to COPD exacerbation frequency.

Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.

6-Minute Walk Work for Assessment of Functional Capacity in Patients With COPD

Pursed lips breathing training using ear oximetry.

A nasal cannula structure capable of being adjusted so as to fit comfortably relative to the nose of a user can be constructed so as to utilize an elongated tubular conduit held by a suitable support so that a portion of the conduit extends beneath and adjacent to the nostrils of the nose of the user. Two separate, spaced holes are provided in this portion of the conduit. Each of these holes is covered by a sleeve which fits closely around the exterior of the conduit in such a manner there is no gas leakage between the exterior of the conduit and the interiors of the sleeves and in such a manner that the positions of the sleeves relative to the conduit can be changed. These sleeves carry small tubes which are in communication with the holes in the conduit and which also extend into the nostrils of a user.

Nasal cannula structure

In accordance with the present invention, a breathing exercise training apparatus is provided for increasing the endurance of inspiratory muscles. This is accomplished by setting a target breathing frequency, target inhalation time and target inhalation pressure on a target generator, and then having the trainee breathe into a resistive breathing device that imposes a predetermined resistance to inhalation and communicates actual inhalation pressure to the target generator. The target generator includes structure for comparing the actual inhalation time and pressure with the target values and provides a feedback signal in response thereto. A preset time interval is provided within which the trainee must attain the target inhalation pressure after an inhalation cycle begins, or a "fault" signal is given to the trainee. Thus, the apparatus of the invention forces the trainee to exercise his inspiratory muscles in order to achieve the target inhalation pressure within the target time.

Brian Tiep

Papers

Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease

6-Minute Walk Work for Assessment of Functional Capacity in Patients With COPD

Pursed lips breathing training using ear oximetry.

Nasal cannula structure

Respiratory training using feedback