Preface
The aim of the GOLD Report is to provide a non-biased review of the current evidence for the assessment, diagnosis
and treatment of people with COPD. One of the strengths of GOLD reports is the treatment objectives. These have
stood the test of time, and are organized into two groups: objectives that are directed towards relieving and reducing
the impact of symptoms, and objectives that reduce the risk of adverse health events that may affect the patient at
some point in the future (exacerbations are an example of such events). This emphasizes the need for clinicians to
focus on both the short-term and long-term impact of COPD on their patients.
A second strength of the original strategy was the simple, intuitive system for classifying COPD severity. This was based
on FEV1 and was called a staging system because it was believed, at the time, that the majority of patients followed a
path of disease progression in which the severity of COPD tracked the severity of airflow obstruction. Much is now
known about the characteristics of patients in the different GOLD stages – for example, their risk of exacerbations,
hospitalization, and death. However, at an individual patient level, FEV1 is an unreliable marker of the severity of
breathlessness, exercise limitation, health status impairment, and risk of exacerbation.
and treatment of people with COPD. One of the strengths of GOLD reports is the treatment objectives. These have
stood the test of time, and are organized into two groups: objectives that are directed towards relieving and reducing
the impact of symptoms, and objectives that reduce the risk of adverse health events that may affect the patient at
some point in the future (exacerbations are an example of such events). This emphasizes the need for clinicians to
focus on both the short-term and long-term impact of COPD on their patients.
A second strength of the original strategy was the simple, intuitive system for classifying COPD severity. This was based
on FEV1 and was called a staging system because it was believed, at the time, that the majority of patients followed a
path of disease progression in which the severity of COPD tracked the severity of airflow obstruction. Much is now
known about the characteristics of patients in the different GOLD stages – for example, their risk of exacerbations,
hospitalization, and death. However, at an individual patient level, FEV1 is an unreliable marker of the severity of
breathlessness, exercise limitation, health status impairment, and risk of exacerbation.
At the time of the original report, improvement in both symptoms and health status was a GOLD treatment objective,
but symptoms assessment did not have a direct relation to the choice of management, and health status measurement
was a complex process largely confined to clinical studies. Now, there are simple and reliable questionnaires designed
for use in routine daily clinical practice. These are available in many languages. These developments have enabled an
assessment system to be developed that draws together a measure of the impact of the patient’s symptoms and an
assessment of the patient’s risk of having a serious adverse health event. This management approach can be used in any clinical setting anywhere in the world and moves COPD treatment towards individualized medicine – matching the patient’s therapy more closely to this or her needs
but symptoms assessment did not have a direct relation to the choice of management, and health status measurement
was a complex process largely confined to clinical studies. Now, there are simple and reliable questionnaires designed
for use in routine daily clinical practice. These are available in many languages. These developments have enabled an
assessment system to be developed that draws together a measure of the impact of the patient’s symptoms and an
assessment of the patient’s risk of having a serious adverse health event. This management approach can be used in any clinical setting anywhere in the world and moves COPD treatment towards individualized medicine – matching the patient’s therapy more closely to this or her needs
BACKGROUND
Chronic Obstructive Pulmonary Disease (COPD) is now one of the top three causes of death worldwide and 90% of
these deaths occur in low- and middle-income countries (LMICs).
(1,2) More than 3 million people died of COPD in 2012
accounting for 6% of all deaths globally. COPD represents an important public health challenge that is both preventable
and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer
from this disease for years and die prematurely from it or its complications. Globally, the COPD burden is projected to
increase incoming decades because of continued exposure to COPD risk factors and aging of thepopulation.
(3)
In 1998, with the cooperation of the National Heart, Lung, and Blood Institute, National Institutes of Health and the
World Health Organization the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was implemented. Its
goals were to increase awareness of the burden of COPD and to improve prevention and management of COPD
through a concerted worldwide effort of people involved in all facets of healthcare and healthcare policy. An important
and related goal was to encourage greater research interest in this highly prevalent disease.
In 2001, GOLD released its first report, Global Strategy for the Diagnosis, Management, and Prevention of COPD. This
report was not intended to be a comprehensive textbook on COPD, but rather to summarize the current state of the field. It was developed by individuals with expertise in COPD research and patient care and was based on the best-
validated concepts of COPD pathogenesis at that time, along with available evidence on the most appropriate
management and prevention strategies. It provided state-of-the-art information about COPD for pulmonary specialists
and other interested physicians and served as a source document for the production of various communications for
other audiences, including an Executive Summary, a Pocket Guide for Healthcare Professionals, and a Patient Guide.
Immediately following the release of the first GOLD report in 2001, the GOLD Board of Directors appointed a Science
Committee, charged with keeping the GOLD documents up-to-date by reviewing published research, evaluating the
impact of this research on the management recommendations in the GOLD documents, and posting yearly updates of
these documents on the GOLD website.
In 2018 GOLD held a one-day summit to consider information about the epidemiology, clinical features, approaches
to prevention and control, and the availability of resources for COPD in LMICs.(1) Major conclusions of the summit
included that: there are limited data about the epidemiological and clinical features of COPD in LMICs but the data
available indicate there are important differences in these features around the world; there is widespread availability
of affordable tobacco products as well as other exposures (e.g., household air pollution) thought to increase the risk
of developing COPD; diagnostic spirometry services are not widely available and there are major problems with access
to affordable quality-assured pharmacological and non-pharmacological therapies. GOLD is therefore concerned that
COPD is not being taken seriously enough at any level, from individuals and communities, to national governments
and international agencies.(4)
It is time for this to change and the GOLD Board of Directors challenge all relevant
stakeholders to work together in coalition with GOLD to address the avoidable burden of COPD worldwide. GOLD is
committed to improving the health of people at risk of and with COPD, wherever they happen to have been born, and
wishes to do its bit to help achieve the United Nations Sustainable Development Goal 3.4 to reduce premature mortality from non-communicable diseases - including COPD - by one third by 2030.
these deaths occur in low- and middle-income countries (LMICs).
(1,2) More than 3 million people died of COPD in 2012
accounting for 6% of all deaths globally. COPD represents an important public health challenge that is both preventable
and treatable. COPD is a major cause of chronic morbidity and mortality throughout the world; many people suffer
from this disease for years and die prematurely from it or its complications. Globally, the COPD burden is projected to
increase incoming decades because of continued exposure to COPD risk factors and aging of thepopulation.
(3)
In 1998, with the cooperation of the National Heart, Lung, and Blood Institute, National Institutes of Health and the
World Health Organization the Global Initiative for Chronic Obstructive Lung Disease (GOLD) was implemented. Its
goals were to increase awareness of the burden of COPD and to improve prevention and management of COPD
through a concerted worldwide effort of people involved in all facets of healthcare and healthcare policy. An important
and related goal was to encourage greater research interest in this highly prevalent disease.
In 2001, GOLD released its first report, Global Strategy for the Diagnosis, Management, and Prevention of COPD. This
report was not intended to be a comprehensive textbook on COPD, but rather to summarize the current state of the field. It was developed by individuals with expertise in COPD research and patient care and was based on the best-
validated concepts of COPD pathogenesis at that time, along with available evidence on the most appropriate
management and prevention strategies. It provided state-of-the-art information about COPD for pulmonary specialists
and other interested physicians and served as a source document for the production of various communications for
other audiences, including an Executive Summary, a Pocket Guide for Healthcare Professionals, and a Patient Guide.
Immediately following the release of the first GOLD report in 2001, the GOLD Board of Directors appointed a Science
Committee, charged with keeping the GOLD documents up-to-date by reviewing published research, evaluating the
impact of this research on the management recommendations in the GOLD documents, and posting yearly updates of
these documents on the GOLD website.
In 2018 GOLD held a one-day summit to consider information about the epidemiology, clinical features, approaches
to prevention and control, and the availability of resources for COPD in LMICs.(1) Major conclusions of the summit
included that: there are limited data about the epidemiological and clinical features of COPD in LMICs but the data
available indicate there are important differences in these features around the world; there is widespread availability
of affordable tobacco products as well as other exposures (e.g., household air pollution) thought to increase the risk
of developing COPD; diagnostic spirometry services are not widely available and there are major problems with access
to affordable quality-assured pharmacological and non-pharmacological therapies. GOLD is therefore concerned that
COPD is not being taken seriously enough at any level, from individuals and communities, to national governments
and international agencies.(4)
It is time for this to change and the GOLD Board of Directors challenge all relevant
stakeholders to work together in coalition with GOLD to address the avoidable burden of COPD worldwide. GOLD is
committed to improving the health of people at risk of and with COPD, wherever they happen to have been born, and
wishes to do its bit to help achieve the United Nations Sustainable Development Goal 3.4 to reduce premature mortality from non-communicable diseases - including COPD - by one third by 2030.
