Current Controversies in Chronic Obstructive Pulmonary Disease. A Report from the Global Initiative for Chronic Obstructive Lung Disease Scientific Committee

Abstract

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable leading cause of worldwide morbidity and mortality that markedly increases healthcare costs. Smoking cessation, vaccinations, supplemental oxygen for hypoxemic patients, and lung volume reduction surgery in selected patients all improve survival; smoking cessation also attenuates disease progression. Several inhaled, oral, and systemically administered drugs improve lung function, decrease the frequency and severity of COPD exacerbations, and improve patients’ quality of life. Pulmonary rehabilitation, noninvasive ventilation, and lung volume reduction also improve outcomes in selected patients. Despite these efforts, COPD continues to claim many lives and disable many more. COPD is a complex process with protean pulmonary and nonpulmonary manifestations punctuated by episodic escalations of respiratory symptoms in a predominately older patient population with multiple comorbid conditions. The major objective of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) is to improve the diagnosis, assessment, and prevention of COPD by increasing awareness while simultaneously stimulating new research. GOLD publishes an annual report that provides recommendations; however, it is clear that some major issues regarding COPD management are not certain and that limited or contradictory data exist in important areas that require further information to guide recommendations. The GOLD scientific committee recently conducted a public forum at which controversial topics were discussed to define the current gaps in knowledge regarding the diagnosis, assessment, and treatment of COPD. These topics included 1) diagnosis and assessment, 2) risk factors for disease development, 3) advances in treatment of the stable patient, and 4) the assessment and treatment of exacerbations. This perspective summarizes that discussion and provides information about current research needs.