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The GOLD is a consensus summarizing current evidence gathered to assess, diagnose and manage patients with chronic obstructive pulmonary disease (COPD). Each year, this GOLD document is enriched with new studies and articles. The year 2023 was special because more than 387 new references were added. These new developments have considerably modified the diagnostic and therapeutic approaches to COPD.
Le GOLD est un consensus résumant les preuves actuelles rassemblées pour évaluer, diagnostiquer et prendre en charge les patients atteints de bronchopneumopathie chronique obstructive (BPCO). Chaque année, ce document GOLD s'enrichit de nouvelles études et articles. L'année 2023 a été particulière puisque plus de 387 nouvelles références ont été ajoutées. Ces nouveautés ont considérablement modifié les approches diagnostique et thérapeutique de la BPCO.
Assuntos
Doença Pulmonar Obstrutiva Crônica , Humanos , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapiaRESUMO
INTRODUCTION: The objective of this Delphi study was to understand and assess the level of consensus among respiratory experts on the clinical application of GOLD 2023 recommendations in management of patients with chronic obstructive pulmonary disease (COPD). METHODS: The study comprised two online surveys and a participant meeting with 34 respiratory experts from 16 countries. Responses of 73 questions were recorded using a Likert scale ranging from 0 (disagreement) to 9 (agreement). The consensus threshold was 75%. RESULTS: Survey 1 and survey 2 had 34 and 32 participants, respectively; and 25 attended the participant meeting. Consensus was reached on survey 1: 28/42; survey 2: 18/30 close-ended questions. A consensus was reached on the clinical relevance of most updates in definitions and diagnosis of COPD. Mixed results for the treatment recommendations by GOLD were noted: 74% agreed with the recommendation to initiate treatment with dual bronchodilators for group E patients; 63% agreed for including inhaled corticosteroids (ICS)/long-acting ß2 agonist(LABA)/ Long-acting muscarinic receptor antagonists (LAMA) as a treatment option for GOLD B patients. Also, consensus lacked on removing ICS + LABA as an initial therapeutic option, in countries with challenges in access to other treatment option;. 88% agreed that they use GOLD recommendations in their daily clinical practice. CONCLUSIONS: This Delphi study demonstrated a high level of consensus regarding key concepts of GOLD 2023 report, with most participants favoring recent updates in definitions, diagnosis, management, and prevention of COPD. More evidence on the etiotype based management and treatment options for group B and E are required which could further strengthen clinical application of the GOLD report.
The goal of this Delphi study was to understand and assess the level of alignment among the respiratory experts on the application of key changes and recommendations proposed by the GOLD 2023 report in their routine clinical practice for the management of patients with chronic obstructive pulmonary disease (COPD). There were two online surveys in this study, and experts from 16 countries (primarily focused on developing countries) were invited to participate. Using the Delphi method, expert representatives shared their insights with the aim of optimizing patient care. The alignment was assessed in six well-defined themes: 1) Overall view on GOLD/other recommendations; 2) Assessing patients with COPD; 3) Initial pharmacological treatment in patients with COPD; 4) Vaccination for patients with COPD; 5) Follow-up pharmacological treatment in patients with COPD; and 6) Survival evidence in patients with COPD. Participants expressed a high level of agreement regarding key concepts of the GOLD 2023 report, with most of them agreeing with recent updates in definitions, diagnosis, management, and prevention of COPD. The results also highlighted the need to publish GOLD reports in multiple languages and in a shorter, pocket-sized format to increase awareness and adaptation among healthcare providers.
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Background: The revised Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 group ABE classification has undergone major modifications, which can simplify clinical assessment and optimize treatment recommendations for Chronic Obstructive Pulmonary Disease (COPD). However, the predictive value of the new grouping classification for prognosis is worth further exploration. We aimed to compare the prediction of hospitalization and mortality between this new GOLD group 2023 ABE classification and the earlier 2017 ABCD classification in a Chinese COPD cohort. Methods: Data from 2,499 outpatients with COPD, who first registered in the RealDTC study of Second Xiangya Hospital from December 2016 to December 2019, were collected prospectively and assessed retrospectively. Patients were followed up on all-cause mortality until October 2022 or death. Results: Of the 2,499 patients with COPD, the risk of hospitalization during the first-year follow-up was higher in group E than in groups A and B. The mortality was higher in group E than in groups A and B, and group B was higher than group A. No differences were seen in the area under the curve (AUC) of 2017 vs 2023 GOLD grouping to predict hospitalization. The time-dependent AUC and concordance index for predicting mortality is slightly higher in the GOLD 2017 ABCD than in the 2023 ABE groups. The new GOLD 12-subgroup (1A-4E) classification combining the GOLD 1-4 staging and grouping performed similarly discriminate predictive power for mortality to the GOLD 2017 16-subgroup (A1-4D) classification. Conclusion: The risk of hospitalization during the first-year follow-up was higher in group E than in groups A and B. The all-cause mortality increased gradually from GOLD group A to E. The GOLD 2023 classification based on ABE groups did not predict mortality better than the earlier 2017 ABCD classifications.