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

This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD 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 pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.

/pdf/global-strategy-for-the-diagnosis-management-and-prevention-3ziakcdle4.pdf

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

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: (i) 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; (ii) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; (iii) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; (iv)non-pharmacological therapies are comprehensively presented and (v) the importance of co-morbid conditions in managing COPD is reviewed.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.13012

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

https://www.thelancet.com/pdfs/journals/lanres/PIIS2213-2600(15)00106-X.pdf

Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials

https://www.atsjournals.org/doi/pdf/10.1513/pats.200512-129SF

Chronic obstructive pulmonary disease

BACKGROUND: Exacerbations of chronic obstructive pulmonary disease (COPD) are associated with accelerated loss of lung function and death. Identification of patients at risk for these events, particularly those requiring hospitalization, is of major importance. Severe pulmonary hypertension is an important complication of advanced COPD and predicts acute exacerbations, though pulmonary vascular abnormalities also occur early in the course of the disease. We hypothesized that a computed tomographic (CT) metric of pulmonary vascular disease (pulmonary artery enlargement, as determined by a ratio of the diameter of the pulmonary artery to the diameter of the aorta [PA:A ratio] of >1) would be associated with severe COPD exacerbations. METHODS: We conducted a multicenter, observational trial that enrolled current and former smokers with COPD. We determined the association between a PA:A ratio of more than 1 and a history at enrollment of severe exacerbations requiring hospitalization and then examined the usefulness of the ratio as a predictor of these events in a longitudinal follow-up of this cohort, as well as in an external validation cohort. We used logistic-regression and zero-inflated negative binomial regression analyses and adjusted for known risk factors for exacerbation. RESULTS: Multivariate logistic-regression analysis showed a significant association between a PA:A ratio of more than 1 and a history of severe exacerbations at the time of enrollment in the trial (odds ratio, 4.78; 95% confidence interval [CI], 3.43 to 6.65; P 1), as detected by CT, was associated with severe exacerbations of COPD. (Funded by the National Heart, Lung, and Blood Institute; ClinicalTrials.gov numbers, NCT00608764 and NCT00292552.).

https://www.nejm.org/doi/pdf/10.1056/NEJMoa1203830

Pulmonary arterial enlargement and acute exacerbations of COPD.

CT Detected Pulmonary Hypertension Is Associated With Severe COPD Exacerbation In The COPDgene Population

Objectives: To find out the level of stress among the doctor community before and during the COVID-19 pandemic in different public sector hospitals. 
Study Design: Cross-sectional study. 
Place and Duration of Study: Divisional Headquarters DHQ Teaching Hospital, Sahiwal Pakistan and two Public Sector Hospitals at Okara and Islamabad Pakistan, from Aug 2019 to Aug 2020. 
Methodology: A total of 320 doctors in two Groups were included in the study. Group-1 included 197 doctors in pre-COVID-19 time i-e from Aug 2019 to Jan 2020, while Group-2 included 123 doctors working in the COVID-19 scenario. The stress was assessed according to responses on a structured questionnaire and patient health questionnaire (PHQ-9) scores. 
Results: Three hundred and twenty doctors participated in the study, out of which 78(39.8%) doctors in the First Group and 49(40.4%) in Second Group developed depression during their duties. More female doctors participated in the study, most of whom were young doctors who were actively involved in COVID-19 patients. 
Conclusion: There is no significant rise in stress among the doctors working in the COVID-19 situation in public sector hospitals of Pakistan.

/pdf/level-of-general-stress-in-doctors-community-in-pre-and-post-2lcz1dgd.pdf

Naseer Abbas

Papers

Pulmonary arterial enlargement and acute exacerbations of COPD.

CT Detected Pulmonary Hypertension Is Associated With Severe COPD Exacerbation In The COPDgene Population

Level of General Stress in Doctors Community in Pre and Post Covid-19 Scenario in Different Hospitals of Pakistan