The GOLD Report 2023 includes 387 new references, updates for the diagnosis and treatment of COPD, reclassifies patients into three groups, and makes changes to initial medications by patient group, among many other things.
We have prepared for you a summary of some of the main updates 2023 of this Clinical Practice Guideline for the approach, diagnosis, and treatment of the disease.
New COPD definition
New COPD definition
The GOLD 2023 Report indicates that COPD is a heterogeneous disease characterized by chronic respiratory symptoms including dyspnea, cough, sputum production and/or exacerbations. This is due to airway and/or alveoli abnormalities, resulting in persistent, and often progressive, airway obstruction.
Redefining exacerbated COPD
Redefining exacerbated COPD
The Report considers exacerbated COPD to be an event characterized by increased dyspnea and/or cough and sputum that worsens within < 14 days. It may be accompanied by tachypnea and/or tachycardia and is often associated with increased local and systemic inflammation caused by infection, pollution, or other airway aggressors.
Chronic Bronchitis
Chronic Bronchitis
A section on Chronic Bronchitis was added to this new version of the Guide. It is considered a common, but variable, condition in COPD patients. It is defined by the regular presence of cough with sputum production, during a defined period.
- The variability of the prevalence of Chronic Bronchitis (CB) depends on the definition used as a parameter, which differs regarding the regularity and duration of symptoms.
- Factors associated with the prevalence of CB in COPD include: male sex, young age, higher number of packs of cigarettes per year, more severe airway obstruction, living in a rural community, and increased occupational exposure.
- Although smoking predisposes to Chronic Bronchitis, it was found that 4-22% of patients are non-smokers, indicating that there are other factors associated with this disease.
2023 GOLD Report, considerations for Spirometry
- Forced spirometry is the most reproducible and objective measure of airway obstruction.
- This test is non-invasive, reproducible, economically viable and easily accessible. Therefore, it should be available in any medical setting and all healthcare professionals treating COPD patients should have access to spirometry devices.
- However, peak expiratory flow by itself does not offer enough reliability to be considered as the only diagnostic test, due to its low specificity.
- Evaluation. Spirometry should be compared with appropriate reference values that consider the patient's age, height, sex, and race*. A post-bronchodilator response FEV1/FVC <0.7 confirms the presence of non-fully reversible airway obstruction.
- The GOLD 2023 Guideline highlights that considering a fixed FEV1/FVC ratio <0.7 to define airway obstruction can lead to overdiagnosis in older adult patients and underdiagnosis in young adults.
- Assessing the degree of reversibility of airway obstruction (i.e by measuring FEV1 before and after bronchodilators or corticosteroids) to make treatment decisions is no longer recommended.
* NOTE. On March, 27th, 2023, The American Thoracic Society published an Official Statement explaining why race and ethnicity SHOULD NO LONGER be considered in interpreting a spirometry. To read the statement click here.
While spirometry is a reliable test for diagnosing COPD, at SCHILLER we agree that there are cases where this test is not enough. That is why, in addition to our spirometer, SpiroScout, we make available to pulmonary specialists (i.e pulmonologists) the PowerCube Body+ Body Plethysmograph for much comprehensive tests (check if it is available in your country). Both devices use ultrasonic technology.
Reducing COPD mortality
Reducing COPD mortality
The Report added Table 3.6 (page 68), a document containing information on the clinical evidence (RCT - Randomized Controlled Trials) that support the reduction of mortality of patients suffering from COPD, both using pharmacotherapy and non-pharmacological therapy. Here we summarize some results, please review the table in the GOLD Guide 2023 for data references.
Pharmacotherapy
Therapy. LABA + LAMA + ICS. (LABA- Long-Acting Beta-Agonists. LAMA – Long-Acting Antimuscarinic. ICS – Inhaled corticosteroids).
IMPACT Clinical Trial: HR 0.72 (95% CI: 0.53, 0.99)
ETHOS Clinical Ttrial: HR 0.51 (95% CI: 0.33, 0.80)
Non-pharmacological therapies
Therapy. Smoking cessation.
Therapy. Pulmonary rehabilitation.
Therapy. Long-term oxygen therapy.
Therapy. Non-invasive positive pressure ventilation.
Therapy. Lung volume reduction surgery.
Other highlights
Other highlights
In addition to what we already listed above, there are several novelties worth mentioning here:
- There is a new table (1.1) with COPD Etiotypes. Page 18
- Table 2.8 was included with information on the use of CT. Page 44
- Vaccine recommendations for COPD patients have been updated according to the CDC. Page 54
- Information on adherence to inhaled medicinal products was included. Page 71
- There is a section dedicated to Tele-rehabilitation. Pages 76
- A section dedicated to the choice of inhaler type was added. Page 112
- A new table (5.3) on Diagnosis and Assessment is included. Page 139
As you know, the GOLD Report is a very long document. We hope you find this summary of some of its highlights useful to find out about the 2023 changes in a practical way.
