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Optimizing the management of chronic obstructive pulmonary disease: applying the GOLD strategy
Anthony DUThe goals for management of stable chronic obstructive pulmonary disease (COPD) as per the latest Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 revision include reducing both symptoms (modified medical research council dyspnea score and/or COPD assessment tool) and future risk (severity of airflow limitation and/or exacerbation history in the previous year). Bronchodilators remain central to the management of COPD; a combination of long-acting bronchodilators from different pharmacological classes is recommended to achieve maximal bronchodilation in patients not controlled with monotherapy alone. Presently, several issues related to COPD management remain unaddressed, perhaps due to the paucity of evidence – when should bronchodilator therapy be stepped up, what is the value of early diagnosis and treatment of COPD; how appropriate is long-acting bronchodilator therapy in early disease, and what is the role of inhaled corticosteroids in COPD? The intent of this review is to address the issues highlighted above using a pragmatic and evidence-based approach that can be utilized by both primary and specialty care providers.