New COPD GOLD Classification

1
New COPD GOLD Classification
2
Objectives

• Defining COPD
• To be familiar with the new GOLD classification
  system

3
COPD Defined by GOLD

• COPD as a disease state is characterized by
  airflow limitation that is usually progressive
  and associated with an enhanced chronic
  inflammatory response in the airways and the lung
  to noxious particles or gases.

4
OLD Subtypes

• Chronic bronchitis
• chronic productive cough for 3 months in 2
  consecutive years.
• Emphysema
• Abnormal and permanent enlargement of the
  airspaces distal to the terminal bronchioles,
  accompanied by destruction of airspace walls
  without obvious fibrosis.
• Chronic obstructive asthma
• Asthma with airflow obstruction that does not
  remit completely

5
revised GOLD classification

• Looks at 3 things
• Symptoms
• FEV1
• History of exacerbations

6
Grading symptoms
7
Grading severity of airflow
In patients with FEV1/FVC lt0.70 In patients with FEV1/FVC lt0.70 In patients with FEV1/FVC lt0.70
GOLD 1 Mild FEV1gt80
GOLD 2 Moderate 50ltFEV1lt80
GOLD 3 Severe 30ltFEV1lt50
GOLD 4 Very severe FEV1lt30
8
history
9
CASE

• 74 YO M with COPD p/w SOB x 2 days. At baseline
  he does not have any physical limitations. His
  last spirometry three years ago showed mild COPD.
  He was never given any inhalers besides a rescue
  inhaler that he seldom uses. He has never been
  intubated, but gets about 3 exacerbations per
  year. 2 days ago he required it around the clock
  after having URI symptoms. He has increased
  greenish sputum over the past couple of days. He
  called 911 after waking up SOB. He was given
  duonebs and placed on CPAP.
• What classification is he?

10
summary

• COPD is characterized by airflow limitation,
  progressive, and has an enhanced chronic
  inflammatory response.
• Revised GOLD classification uses FEV1, symptoms,
  history of exacerbations
• Its still important to know the OLD FEV1
  classification system because its used in the
  NEW GOLD classification.
• For diagnosis and exacerbation treatment of COPD,
  see the newly revised COPD mini lecture!

11
References

• Global Strategy for the Diagnosis, Management,
  and Prevention of COPD Updated 2013
• Uptodate