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.

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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

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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.

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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

Patients with COPD may require treatment with triple therapy of LABA/LAMA/ICS (Triple). Higher blood eosinophils are associated with an increased risk of acute exacerbations of COPD (AECOPD) and indicate greater probability of benefit from ICS and treatments targeting eosinophilic inflammation (EOS). The prevalence of patients with higher blood EOS levels still experiencing frequent or severe exacerbations in spite of Triple is unknown. Methods: This post-hoc analysis was conducted using the ACCESS study (GSK115058; NCT01516528), a prospective cohort of patients with COPD recruited from primary care across 6 European countries in 2011-12. Prevalence was evaluated based on the following baseline visit criteria: (a) treated with Triple; (b) EOS ≥ 150 cells/µL; (c) EOS≥300 cells/µL; (d) ≥ 2moderate/≥1hospitalized AECOPDs in the 12 months prior to baseline. Results: Of 2,887 evaluable participants: 7.2% were Triple users and had a history of frequent/hospitalized AECOPDs; 4.3% and 1.8% were Triple users with a history of frequent/hospitalized AECOPDs and with EOS ≥ 150 or ≥ 300 cells/µL, respectively (Table 1). Conclusions: In this primary care COPD cohort, we identified a small number of participants with frequent/hospitalized AECOPD whilst treated with Triple who also had higher EOS levels. These patients may benefit from medicines targeting eosinophil associated inflammation. GSK study RWD206; NCT01516528

Exacerbations and Eosinophil Levels in ACCESS Cohort Participants Prescribed Inhaled Triple Therapy

Background: Lower respiratory tract infections (LRTIs) before COPD diagnosis may be a risk factor for higher COPD burden. Aims: To explore the association between pre-COPD diagnosis LRTIs and post-COPD diagnosis exacerbations and mortality. Methods: An observational UK cohort study was conducted using CPRD linked with hospitalisations and death statistics. People with a first-ever COPD diagnosis between 2004-2019 were included. LRTIs were mild (GP visit + no antibiotics), moderate (GP + antibiotics), or severe (hospitalisation). Six mutually-exclusive exposure groups were: no LRTI, 1 mild, 2+ mild, 1 moderate, 2+ moderate, 1+ severe 12 months preceding inclusion. Post-COPD diagnosis outcomes were (i) number of exacerbations, (ii) death due to any cause, COPD or cardiovascular disease (CVD). Poisson regression models adjusted on baseline confounders were used. Results: 215,234 patients were included. Compared with no LRTI (ref), patients with 1 moderate (IRR 1.9; 95%CI 1.9-1.9), 2+ moderate (IRR 2.6; 95%CI 2.6-2.6), or 1+ severe (IRR 1.2; 95% CI 1.2-1.2) LRTIs were at increased risk of exacerbation. All-cause mortality was increased in patients with 1 moderate (IRR 1.3; 95%CI 1.2-1.3), 2+ moderate (IRR 1.4; 95%CI 1.3-1.4), or 1+ severe (IRR 1.3; 95% CI 1.2-1.3) LRTIs.&nbsp;Similar results&nbsp;were found for COPD mortality. Only moderate LRTIs were&nbsp;associated with increased CVD mortality. Mild events were inconsistently associated with outcomes. Conclusion: LRTIs&nbsp;prior to diagnosis are indicative of worse COPD outcomes.&nbsp;This may offer an opportunity for disease modification through prompt diagnosis and pro-active management.

Frequency and severity of respiratory infections prior to COPD diagnosis and risk of subsequent post-diagnosis COPD exacerbations and mortality: a UK routine health care data study

Hana Müllerová

Papers

Exacerbations and Eosinophil Levels in ACCESS Cohort Participants Prescribed Inhaled Triple Therapy

Frequency and severity of respiratory infections prior to COPD diagnosis and risk of subsequent post-diagnosis COPD exacerbations and mortality: a UK routine health care data study

Occurrence And Descriptors Of Severe COPD Exacerbations In The ECLIPSE Cohort

Incremental Burden Of Dyspnea In COPD To A Primary Care COPD Population

Fatigue In COPD Is Significantly Associated With Exacerbations; Data From The Eclipse Cohort Study