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

Cross-Sectional Associations Between the Chronic Airways Assessment Test and Clinical Characteristics in Asthma and/or COPD in the NOVELTY Study

<h3>Introduction and Objectives</h3> Oral corticosteroids (OCS) are sometimes used to manage exacerbations in patients with chronic obstructive pulmonary disease (COPD). Evidence suggests chronic OCS use is related to adverse outcomes, which may be associated with additional healthcare resource utilisation (HCRU) and costs. The objective of this study was to compare HCRU in patients who ever or never used OCS (OCS vs non-OCS cohorts) and to examine associations between cumulative OCS exposure and HCRU/costs. <h3>Methods</h3> This matched historical observational cohort study used the UK Clinical Practice Research Datalink (1987–2019). Patients with a COPD diagnosis on/after 1 April 2003 and Hospital Episode Statistics linkage were included. Attendances for emergency room, specialist or primary care (PC) outpatient and inpatient visits were analysed. Costs were estimated using Health and Social Care 2019 and NHS Reference Costs 2019–2020 reports. <h3>Results</h3> Compared with the non-OCS cohort, the OCS cohort had higher annualised total attendances and costs (table 1). Compared with patients with cumulative OCS doses &lt;0.5 g, patients with higher cumulative doses had higher costs (incidence rate ratios; 95% CI) starting at 0.5–&lt;1.0 g for specialist consultations (1.91; 1.89, 1.93), inpatient non-elective short stays (1.10; 1.09, 1.12) and long stays (1.039; 1.036, 1.042) and PC consultations (1.274; 1.267, 1.281). <h3>Conclusions</h3> OCS use is associated with increased HCRU and costs, with a positive dose-response relationship. Please refer to page A216 for declarations of interest related to this abstract. 

P214 Oral corticosteroid-related healthcare resource utilisation in patients with COPD

Associations Between the Chronic Airways Assessment Test and History of Physician-Reported Exacerbations in Asthma and/or COPD in the NOVELTY Study

<b>Background:</b> In clinical studies, poorer COPD health status is associated with increased exacerbation risk. <b>Aim:</b> To evaluate this relationship in a global cohort of patients with a physician-assigned COPD diagnosis. <b>Methods:</b> Patients with a physician-assigned COPD diagnosis without concomitant asthma from NOVELTY (NCT02760329), recruited from primary (46%) and secondary care, were included. Health status was assessed using baseline SGRQ total score; physician-reported exacerbations were collected at 1-year follow-up. A negative binomial regression model assessed the relationship between SGRQ at baseline and exacerbations (adjusted for age, sex, smoking status, prior exacerbations) at 1-year follow-up. <b>Results:</b> Of 2,123 patients with COPD (mean age 67.2 [SD 9.0] years, 38% female, mean post-BD FEV<sub>1</sub> 61% [SD 23%] predicted), 74% had SGRQ total score ≥25 at baseline (overall mean 40.6 [SD 21.6]). At 1-year follow-up, mean exacerbation risk was 0.51, 1.67, 0.62 and 0.21 events/patient/year in patients overall, with ≥1 event, with SGRQ total score ≥25 and with SGRQ total score &lt;25, respectively. A 4-point increase in baseline SGRQ total score was associated with a 6% increase in 1-year exacerbation risk (relative risk: 1.06; 95% CI 1.05, 1.08; p&lt;0.001). <b>Conclusions:</b> In this real-world population of patients with COPD, predominantly with mild/moderate airflow limitation, with a large proportion from primary care, exacerbation risk increased with poorer baseline COPD health status, independent of age, sex, smoking status and prior exacerbations. Patients with higher symptom burden should be considered for treatment optimisation to reduce their risk of future exacerbations. 

Health status relationship with exacerbations in a real-world cohort of patients with physician-assigned COPD in NOVELTY

Introduction In patients with chronic obstructive pulmonary disease (COPD), the risk of certain cardiovascular (CV) events is increased by threefold to fivefold in the year following acute exacerbation of COPD (AECOPD), compared with a non-exacerbation period. While the effect of severe AECOPD is well established, the relationship of moderate exacerbation or prior exacerbation to elevated risk of CV events is less clear. We will conduct cohort studies in multiple countries to further characterise the association between AECOPD and CV events. Methods and analysis Retrospective longitudinal cohort studies will be conducted within routinely collected electronic healthcare records or claims databases. The study cohorts will include patients meeting inclusion criteria for COPD between 1 January 2014 and 31 December 2018. Moderate exacerbation is defined as an outpatient visit and/or medication dispensation/prescription for exacerbation; severe exacerbation is defined as hospitalisation for COPD. The primary outcomes of interest are the time to (1) first hospitalisation for a CV event (including acute coronary syndrome, heart failure, arrhythmias or cerebral ischaemia) since cohort entry or (2) death. Time-dependent Cox proportional hazards models will compare the hazard of a CV event between exposed periods following exacerbation (split into these periods: 1–7, 8–14, 15–30, 31–180 and 181–365 days) and the unexposed reference time period, adjusted on time-fixed and time-varying confounders. Ethics and dissemination Studies have been approved in Canada, Japan, the Netherlands, Spain and the UK, where an institutional review board is mandated. For each study, the results will be published in peer-reviewed journals.

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Hana Müllerová

Papers

Cross-Sectional Associations Between the Chronic Airways Assessment Test and Clinical Characteristics in Asthma and/or COPD in the NOVELTY Study

P214 Oral corticosteroid-related healthcare resource utilisation in patients with COPD

Associations Between the Chronic Airways Assessment Test and History of Physician-Reported Exacerbations in Asthma and/or COPD in the NOVELTY Study

Health status relationship with exacerbations in a real-world cohort of patients with physician-assigned COPD in NOVELTY

EXAcerbations of COPD and their OutcomeS on CardioVascular diseases (EXACOS-CV) Programme: protocol of multicountry observational cohort studies