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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 1998&#44; the Global Initiative for Chronic Obstructive Pulmonary Disease &#40;GOLD&#41; was created as a collaborative effort between the National Heart&#44; Lung and Blood Institute &#40;NHLBI&#41; and the World Health Organization &#40;WHO&#41;&#46; Its primary aim was to focus attention on and to improve treatment and prevention of chronic obstructive lung disease &#40;COPD&#41;&#46; Other objectives were to promote research and provide educational support in this area throughout the world&#46; These objectives are being achieved with the help of patient organizations and foundations&#44; the pharmaceutical industry&#44; government agencies&#44; healthcare suppliers&#44; and stakeholders in COPD research&#44; patient care&#44; and health promotion and disease prevention&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This year&#44; SEPAR is celebrating its &#8220;COPD-Smoking Year&#8221;&#44; the main aim of which is to raise public awareness of COPD and the impact of smoking&#46; It has been 15 years since GOLD published its first strategy paper&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> bringing together the knowledge needed to provide a route map for achieving these objectives&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">After a year as national delegate for GOLD in Spain&#44; I would summarize the distinctive features and strengths of this strategy as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Structure&#46;</span> GOLD is a non-profit-making&#44; non-governmental organization&#44; set up according to formal statutes&#46; It consists of an Executive Committee&#44; a Scientific Committee and 2 staff members &#40;an Executive Director and a Scientific Director&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The Executive Committee meets on a yearly basis and the Scientific Committee meets before the American Thoracic Society &#40;ATS&#41; and European Respiratory Society &#40;ATS&#41; annual meetings&#46; GOLD consists of an expert panel of respiratory medicine specialists&#44; epidemiologists&#44; and health educators&#46; To free itself from dependence on contributions from the pharmaceutical industry&#44; since July 1&#44; 2014&#44; GOLD activities have been funded by revenue from the sale of their documents and resources&#46; These materials can be downloaded from the GOLD website &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.goldcopd.org/">http&#58;&#47;&#47;www&#46;goldcopd&#46;org</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Revisions</span>&#46; In 2001&#44; the GOLD program published its first consensus document&#44; The Global Strategy for the Diagnosis&#44; Management&#44; and Prevention of COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Since then&#44; the guidelines have been updated annually&#44; and in compliance with the original 5-yearly program&#44; they were revised in 2006 and 2011&#46; In the future&#44; in view of the large amount of scientific evidence published every year&#44; we will no longer differentiate between the yearly updates and the 5-yearly revisions&#46; Future topics will include lung cancer screening in COPD patients&#44; the role of statins&#44; withdrawal of inhaled corticosteroids&#44; and comorbidities&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Evidence-based medicine</span>&#46; Since the inception of GOLD&#44; recommendations have been classified according to the level of evidence adjudicated by the authors &#91;from A &#40;randomized clinical trials&#41; to D &#40;expert panels&#41;&#93;&#46; This grading reflects the strength of the evidence supporting each recommendation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical impact</span>&#46; It is unclear whether pharmacological treatment of COPD has changed since the initial version of the document&#46; The latest revision of the GOLD strategy &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> presented a new approach to the multidimensional evaluation of COPD patients in which not only FEV1&#44; but also the patient&#39;s burden of symptoms and the risk of future exacerbations are taken into account&#46; Several studies have used existing patient cohorts initially recruited for other purposes in an attempt to validate this new approach to COPD&#46; For example&#44; Lange et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> studied 6628 COPD patients in a 4-year follow-up&#44; concluding that&#58; &#40;1&#41; the new GOLD classification properly identified patients at risk of exacerbations &#40;the percentage of exacerbations during the first year was 2&#46;2&#37;&#44; 5&#46;8&#37;&#44; 25&#37; and 28&#46;6&#37; in groups A&#44; B&#44; C&#44; and D&#44; respectively&#41;&#44; although the risk of exacerbation in C and D was limited exclusively to frequent exacerbators&#44; but not to those with a FEVI&#60;50&#37;&#59; and &#40;2&#41; despite being theoretically classified as low risk&#44; patients in group B had a higher mortality than those in group C&#44; probably due to cardiovascular or oncological comorbidities&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">GOLD around the world</span>&#46; Firstly&#44; the GOLD consensus has inspired and formed the basis for numerous other clinical guidelines worldwide&#46; A COPD opinion leader network&#44; which participates actively in GOLD&#44; has been set up in several countries&#46; These GOLD national delegates share their ideas and work toward implementing care programs to meet the objectives of the GOLD program&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;6&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Website&#46;</span> To facilitate international communication&#44; GOLD launched a website with the latest news on all GOLD activities and access to educational materials for patients and the general public&#44; available in multiple languages&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;7&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">World COPD Day</span>&#46; GOLD organizes the World COPD Day on the third Wednesday of November&#44; working with healthcare professionals and COPD patient associations to hold awareness-raising events and COPD educational events all over the world&#46; Every year&#44; GOLD chooses a theme and coordinates the preparation and distribution of material for World COPD Day&#46; These materials&#44; together with a full list of the activities programmed for different countries&#44; can be downloaded from the website &#40;<a id="intr0015" class="elsevierStyleInterRef" href="http://www.goldcopd.org/wcd-home.html">http&#58;&#47;&#47;www&#46;goldcopd&#46;org&#47;wcd-home&#46;html</a>&#41;&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; the GOLD strategy paper is a living document with a worldwide impact&#44; which aims to improve awareness of the disease and care of COPD patients&#46; In the future&#44; GOLD will expand its activities via the website&#46; A greater number of translations will be available online&#44; and apps will be created to facilitate access from a variety of platforms&#46;</p></span>"
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Editorial
GOLD: Its Good Points
GOLD: puntos a favor
Patricia Sobradillo Ecenarro
Corresponding author
psobradillo@separ.es

Corresponding author.
, David Bravo Blanco
Servicio de Neumología, Hospital Universitario Araba, Vitoria, Álava, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In 1998&#44; the Global Initiative for Chronic Obstructive Pulmonary Disease &#40;GOLD&#41; was created as a collaborative effort between the National Heart&#44; Lung and Blood Institute &#40;NHLBI&#41; and the World Health Organization &#40;WHO&#41;&#46; Its primary aim was to focus attention on and to improve treatment and prevention of chronic obstructive lung disease &#40;COPD&#41;&#46; Other objectives were to promote research and provide educational support in this area throughout the world&#46; These objectives are being achieved with the help of patient organizations and foundations&#44; the pharmaceutical industry&#44; government agencies&#44; healthcare suppliers&#44; and stakeholders in COPD research&#44; patient care&#44; and health promotion and disease prevention&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This year&#44; SEPAR is celebrating its &#8220;COPD-Smoking Year&#8221;&#44; the main aim of which is to raise public awareness of COPD and the impact of smoking&#46; It has been 15 years since GOLD published its first strategy paper&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> bringing together the knowledge needed to provide a route map for achieving these objectives&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">After a year as national delegate for GOLD in Spain&#44; I would summarize the distinctive features and strengths of this strategy as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#40;1&#41;</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Structure&#46;</span> GOLD is a non-profit-making&#44; non-governmental organization&#44; set up according to formal statutes&#46; It consists of an Executive Committee&#44; a Scientific Committee and 2 staff members &#40;an Executive Director and a Scientific Director&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The Executive Committee meets on a yearly basis and the Scientific Committee meets before the American Thoracic Society &#40;ATS&#41; and European Respiratory Society &#40;ATS&#41; annual meetings&#46; GOLD consists of an expert panel of respiratory medicine specialists&#44; epidemiologists&#44; and health educators&#46; To free itself from dependence on contributions from the pharmaceutical industry&#44; since July 1&#44; 2014&#44; GOLD activities have been funded by revenue from the sale of their documents and resources&#46; These materials can be downloaded from the GOLD website &#40;<a id="intr0010" class="elsevierStyleInterRef" href="http://www.goldcopd.org/">http&#58;&#47;&#47;www&#46;goldcopd&#46;org</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#40;2&#41;</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Revisions</span>&#46; In 2001&#44; the GOLD program published its first consensus document&#44; The Global Strategy for the Diagnosis&#44; Management&#44; and Prevention of COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Since then&#44; the guidelines have been updated annually&#44; and in compliance with the original 5-yearly program&#44; they were revised in 2006 and 2011&#46; In the future&#44; in view of the large amount of scientific evidence published every year&#44; we will no longer differentiate between the yearly updates and the 5-yearly revisions&#46; Future topics will include lung cancer screening in COPD patients&#44; the role of statins&#44; withdrawal of inhaled corticosteroids&#44; and comorbidities&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#40;3&#41;</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Evidence-based medicine</span>&#46; Since the inception of GOLD&#44; recommendations have been classified according to the level of evidence adjudicated by the authors &#91;from A &#40;randomized clinical trials&#41; to D &#40;expert panels&#41;&#93;&#46; This grading reflects the strength of the evidence supporting each recommendation&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#40;4&#41;</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical impact</span>&#46; It is unclear whether pharmacological treatment of COPD has changed since the initial version of the document&#46; The latest revision of the GOLD strategy &#40;2011&#41;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> presented a new approach to the multidimensional evaluation of COPD patients in which not only FEV1&#44; but also the patient&#39;s burden of symptoms and the risk of future exacerbations are taken into account&#46; Several studies have used existing patient cohorts initially recruited for other purposes in an attempt to validate this new approach to COPD&#46; For example&#44; Lange et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> studied 6628 COPD patients in a 4-year follow-up&#44; concluding that&#58; &#40;1&#41; the new GOLD classification properly identified patients at risk of exacerbations &#40;the percentage of exacerbations during the first year was 2&#46;2&#37;&#44; 5&#46;8&#37;&#44; 25&#37; and 28&#46;6&#37; in groups A&#44; B&#44; C&#44; and D&#44; respectively&#41;&#44; although the risk of exacerbation in C and D was limited exclusively to frequent exacerbators&#44; but not to those with a FEVI&#60;50&#37;&#59; and &#40;2&#41; despite being theoretically classified as low risk&#44; patients in group B had a higher mortality than those in group C&#44; probably due to cardiovascular or oncological comorbidities&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#40;5&#41;</span><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">GOLD around the world</span>&#46; Firstly&#44; the GOLD consensus has inspired and formed the basis for numerous other clinical guidelines worldwide&#46; A COPD opinion leader network&#44; which participates actively in GOLD&#44; has been set up in several countries&#46; These GOLD national delegates share their ideas and work toward implementing care programs to meet the objectives of the GOLD program&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#40;6&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Website&#46;</span> To facilitate international communication&#44; GOLD launched a website with the latest news on all GOLD activities and access to educational materials for patients and the general public&#44; available in multiple languages&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#40;7&#41;</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">World COPD Day</span>&#46; GOLD organizes the World COPD Day on the third Wednesday of November&#44; working with healthcare professionals and COPD patient associations to hold awareness-raising events and COPD educational events all over the world&#46; Every year&#44; GOLD chooses a theme and coordinates the preparation and distribution of material for World COPD Day&#46; These materials&#44; together with a full list of the activities programmed for different countries&#44; can be downloaded from the website &#40;<a id="intr0015" class="elsevierStyleInterRef" href="http://www.goldcopd.org/wcd-home.html">http&#58;&#47;&#47;www&#46;goldcopd&#46;org&#47;wcd-home&#46;html</a>&#41;&#46;</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion&#44; 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