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.

Coronavirus disease 2019 (COVID-19) has rapidly affected mortality worldwide1. There is unprecedented urgency to understand who is most at risk of severe outcomes, and this requires new approaches for the timely analysis of large datasets. Working on behalf of NHS England, we created OpenSAFELY-a secure health analytics platform that covers 40% of all patients in England and holds patient data within the existing data centre of a major vendor of primary care electronic health records. Here we used OpenSAFELY to examine factors associated with COVID-19-related death. Primary care records of 17,278,392 adults were pseudonymously linked to 10,926 COVID-19-related deaths. COVID-19-related death was associated with: being male (hazard ratio (HR) 1.59 (95% confidence interval 1.53-1.65)); greater age and deprivation (both with a strong gradient); diabetes; severe asthma; and various other medical conditions. Compared with people of white ethnicity, Black and South Asian people were at higher risk, even after adjustment for other factors (HR 1.48 (1.29-1.69) and 1.45 (1.32-1.58), respectively). We have quantified a range of clinical factors associated with COVID-19-related death in one of the largest cohort studies on this topic so far. More patient records are rapidly being added to OpenSAFELY, we will update and extend our results regularly.

/pdf/factors-associated-with-covid-19-related-death-using-30o03flzwm.pdf

Factors associated with COVID-19-related death using OpenSAFELY.

Background: Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope.

Purpose: The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Methods: A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, “Rehabilitation and Chronic Care,” determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members.

Results: An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed.

Conclusions: The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201309-1634ST

/pdf/an-official-american-thoracic-society-european-respiratory-5fbz6s326i.pdf

An official American thoracic society/European respiratory society statement: Key concepts and advances in pulmonary rehabilitation

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 report focuses primarily on the revised and novel parts of the document. The most significant changes include: (1) the assessment of chronic obstructive pulmonary disease has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; (2) for each of the groups A to D, escalation strategies for pharmacologic treatments are proposed; (3) the concept of deescalation of therapy is introduced in the treatment assessment scheme; (4) nonpharmacologic therapies are comprehensively presented; and (5) the importance of comorbid conditions in managing chronic obstructive pulmonary disease is reviewed.

/pdf/global-strategy-for-the-diagnosis-management-and-prevention-2tve0rxywh.pdf

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary

/pdf/2021-esc-guidelines-on-cardiovascular-disease-prevention-in-14ygu7kat1.pdf

2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

Purpose To characterize and estimate the proportion of patients with chronic obstructive pulmonary disease (COPD) who continue to exacerbate while receiving triple therapy and further describe these patients according to blood eosinophil counts. Methods This was an analysis of the 2017 Adelphi Real-World Respiratory Disease Specific Programme (DSP) survey of patients with COPD from France, Germany, Italy, Spain, and the United Kingdom (UK). Demographics were assessed on the date of completion of the physician/patient questionnaire; clinical characteristics were captured for the previous 12 months. The proportion of patients receiving triple therapy, who had experienced ≥2 moderate or ≥1 severe acute exacerbations of COPD (AECOPD) in the 12 months prior to index, and had blood eosinophil counts ≥150 cells/µL (T-AECOPD-EOS150) or ≥300 cells/µL (T-AECOPD-EOS300), were calculated. Results In total, 2876 patients were included of which 762 had an eosinophil value. A higher proportion of patients in the ≥300 cells/μL eosinophil group (55.9%) compared with 150-<300 cells/μL (48.7%) and <150 cells/μL (47.1%) groups experienced ≥2 moderate and/or ≥1 severe AECOPD in the year prior to index. The ≥300 cells/μL eosinophil group had the lowest reported level of health-related quality of life (HRQoL). More severe disease in terms of comorbidities, lung function, healthcare resource use, and HRQoL was seen in patients with ≥2 moderate or ≥1 severe AECOPD in the year prior to index while receiving triple therapy, compared with patients who did not meet these criteria. In total, 10.6% and 6.2% of the COPD population, respectively, met the criteria for the T-AECOPD-EOS150 and T-AECOPD-EOS300 cohorts. Conclusion This analysis demonstrates that there is a subpopulation of patients with COPD who continue to experience exacerbations despite receiving triple therapy; approximately three-quarters of these had eosinophils ≥150 cells/μL and one-third had eosinophils ≥300 cells/μL; these patients may benefit from eosinophil-targeted therapies.

/pdf/exacerbation-frequency-and-eosinophil-counts-among-patients-xtkhfwlg5j.pdf

Exacerbation Frequency And Eosinophil Counts Among Patients With COPD Currently Prescribed Triple Therapy

Factors Associated With Change In COPD Exacerbation Frequency Phenotype

SLS COPD (NCT01551758) was a 12-month, open-label, randomised controlled trial (RCT) that evaluated the effectiveness and safety of initiating fluticasone furoate/vilanterol 100/25µg vs continuing usual care in COPD patients (pts) with exacerbation (Exa) history (Vestbo et al. NEJM 2016). This was the first effectiveness RCT of its kind in UK primary care with broad inclusion criteria and minimal disruption to routine clinical care. The non-interventional ACCESS study (NCT01516528) examined the rate of mod/sev COPD Exa in primary care pts in 6 European countries (GSK Study 115058). The current study describes similarities and differences between SLS COPD and ACCESS datasets. Demographics/clinical characteristics of SLS COPD and ACCESS pts were recorded either at study screening or after randomisation. SLS COPD entry criteria included ≥1 Exa in the preceding 3 yrs. Pt demographics and clinical characteristics in SLS COPD and ACCESS are shown (Table). SLS COPD pts had a higher Exa rate and higher CAT scores than ACCESS pts. Other variables were broadly similar between SLS COPD and ACCESS, and across countries. SLS COPD pts were more severely impacted than ACCESS pts, possibly due to the Exa history inclusion criterion. Otherwise, pt characteristics were largely similar between the UK SLS COPD study and the European countries in the ACCESS population. Funding by GSK: studies 115151 and 115058.

Patient demographics and clinical characteristics in the UK Salford Lung Study (SLS COPD) and the European ACCESS study

Resume Introduction Cet article rapporte les donnees francaises de l’enquete Continuing to confront COPD (C2C) menee en 2013 dans 12 pays. Son objectif etait de decrire les caracteristiques, symptomes et impact global de la bronchopneumopathie chronique obstructive (BPCO) sur l’etat de sante, les activites quotidiennes et professionnelles chez des adultes rapportant soit un diagnostic de BPCO, d’emphyseme ou de bronchite chronique, soit des symptomes de bronchite chronique, presents ou pour lesquels ils etaient traites (« repondants BPCO »). Methodes Des adultes âges de 40 ans ou plus ont ete selectionnes selon une enquete telephonique a composition aleatoire. Les repondants BPCO etaient invites a completer l’enquete. Resultats La proportion de repondants BPCO a ete estimee a 7,5 %. Parmi 300 repondants BPCO, 48 % etaient des hommes, 44 % âges de plus de 70 ans, 45 % en surpoids et 72 % avaient des antecedents de tabagisme. La BPCO avait un impact severe/tres severe (COPD assessement test > 20) sur la sante pour 43 % ; 70 % rapportaient une dyspnee (mMRC ≥ 1) et 65 % une limitation dans plus de 20 % de leurs activites quotidiennes. Le nombre moyen d’exacerbations etait de 2/an et 16 % des patients avaient ete hospitalises pour motif respiratoire dans l’annee ecoulee. Pourtant, 80 % consideraient leur maladie moderement severe. Conclusion L’impact de la BPCO reste sous-estime malgre un retentissement important en termes de symptomes, d’etat de sante et d’exacerbations.

French data from the Continuing to Confront COPD (C2C) survey

Adverse Outcomes Post-Initiation of Systemic Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease: A Long-Term Observational UK-Based Study

Hana Müllerová

Papers

Exacerbation Frequency And Eosinophil Counts Among Patients With COPD Currently Prescribed Triple Therapy

Factors Associated With Change In COPD Exacerbation Frequency Phenotype

Patient demographics and clinical characteristics in the UK Salford Lung Study (SLS COPD) and the European ACCESS study

French data from the Continuing to Confront COPD (C2C) survey

Adverse Outcomes Post-Initiation of Systemic Corticosteroids in Patients with Chronic Obstructive Pulmonary Disease: A Long-Term Observational UK-Based Study