The GOLD Standards
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recently updated clinical guidelines for the diagnosis, management and prevention of chronic obstructive pulmonary disease (COPD). The committee was made up of physicians and health professionals from all parts of the world.
According to their web site at www.goldcopd.org, COPD is now defined as a preventable and the treatable disease. Worldwide the most commonly encountered risk factor for COPD is cigarette smoking. A diagnosis of COPD should be considered in anyone who has difficulty breathing, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease. The diag- nosis should be confirmed by spirom- etry or pulmonary function testing. Know your numbers! FEV1 – or the amount of air you can forcibly exhale in one second – is used to classify the severity of your COPD.
The Committees Classified COPD in Stages
Stage I: Mild COPD
At this stage, the individual may not be aware that his or her lung function is abnormal. Smokers and ex- smokers, people over 40 years old and males have high rates of Mild COPD. Measured FEV1 (forced expirato- ry volume in one second) is greater than or equal to 80% of predicted value.
Stage II: Moderate COPD
This is the stage at which patients typically seek med- ical attention because of chronic respiratory symptoms or an exacerbation of their disease. FEV1 is less than 80% of predicted but greater or equal to 50% of predicted.
Stage III: Severe COPD
Greater shortness of breath, reduced exercise capacity, and repeated exacerbations which have an impact on quality of life mark this stage. FEV1 is less than 50% of predicted but greater or equal to 30% of predicted.
Stage IV: Very Severe COPD
At this stage, quality of life is very apprecia- bly impaired. FEV1 is less than 30% of predicted.
It is important to note that you should not become overly con- cerned if you have a low number. Many people live with less than 30% of their predicted FEV1 for many, many years. These standards are trying to establish a framework for the disease and do not take into account an individual’s symptoms. The GOLD committees are trying to raise awareness of COPD.
Your physician should have you on a COPD management program which includes four components: assess and monitor disease, reduce risk factors, manage stable COPD, and manage exacerbations.
Pharmacologic treatment can prevent and control symptoms, reduce the frequency and severity of exacer- bations, improve health status, and improve exercise tolerance. You need to take your prescribed medication! Patient education can help improve skills, ability to cope with illness, and health status. It is an effective way to accomplish smoking cessation, initiate discussions and understanding of advance directives and end-of-life issues, and improve responses to acute exacerbations. Get involved!
You will find many resources to spread the word about COPD from the National Heart, Blood and Lung Institute who has a campaign called Learn More, Breathe Better. To receive or download information call 1-301-592-8573 or visit their web site at www.nhlbi.nih.gov.