Editorial
GOLD in 2017: A View From the Spanish COPD Guidelines (GesCOPD)
GOLD en 2017: una visión desde la Guía Española de la EPOC (GesEPOC)
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=> "90" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marc Miravitlles, Juan José Soler-Cataluña" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Marc" "apellidos" => "Miravitlles" "email" => array:1 [ 0 => "mmiravitlles@vhebron.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Juan José" "apellidos" => "Soler-Cataluña" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "GOLD en 2017: una visión desde la Guía Española de la EPOC (GesEPOC)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Last November, we saw the publication of the 2017 version of the Global Initiative for Chronic Obstructive Lung Disease strategy (GOLD),<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> yet another step in a process that began when the first document was published in 2001. GOLD has contributed significantly to putting chronic obstructive pulmonary disease (COPD) on the map of diseases affecting global public health, and has helped standardize aspects such as the definition, diagnostic criteria, and general therapeutic approach to COPD. Until the 2011 version, stratification of COPD severity or risk was based on lung function, and this parameter was used to guide pharmacological treatment. This version of GOLD changed the approach to patient evaluation, and recognized that factors other than forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s (FEV<span class="elsevierStyleInf">1</span>) were equally or even more important when selecting treatment, including symptoms and risk level determined according to the frequency of exacerbations. These factors were organized in a grid that defined 4 categories identified by the letters A–D according to the level of symptoms and risk.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> This was an important step in the path toward personalized treatment, but problems soon emerged. Basically, the main issues were that there was more than 1 determinant for each axis in the grid, and a patient classified as C or D according to poor lung function was very different from one classified as C or D due to frequent exacerbations and who, as such, needed a different type of treatment. Moreover, several studies found that depending on whether the modified Medical Research Council (mMRC) dyspnea scale or the COPD Assessment Test (CAT) was used, the same patient could be classified in different categories,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> and that patients classified as B (low risk) had higher mortality than patients classified as C (high risk).<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> These inconsistencies prompted the review that led to the new 2017 version. Some of the most important changes in this new version are that FEV<span class="elsevierStyleInf">1</span> has been excluded from the treatment grid and proposals are given for treatment intensification and tapering in each of the categories A–D.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From the point of view of the official clinical practice guidelines for the treatment of COPD in Spain (GesEPOC),<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> it is worth remembering first and foremost that GOLD is not a clinical guideline, but rather presents strategies that countries can adapt to their own real-world situation. Right from the start, GesEPOC included a number of GOLD principles, but produced a different suite of phenotype-based recommendations, based on an evaluation of the evidence and a multidisciplinary approach.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Phenotypes, for example, were defined according to the descriptions previously published by some of the authors of the GOLD document.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Despite the initial portrayal of phenotypes as “the future of COPD” and the numerous studies that emerged in the following years, the word “phenotype” is still absent from GOLD 2017. The underlying meaning of the concept is, of course, more important than the actual word, and in this respect, the current GOLD grid is now very similar to that of GesEPOC, to the extent that both share the same “<span class="elsevierStyleItalic">y</span>” axis that divides patients into exacerbators and non-exacerbators; the “<span class="elsevierStyleItalic">x</span>” axis, however, is still different. GOLD 2017 once again classifies patients according to mMRC or CAT, while the GesEPOC uses the standard clinical phenotypes: emphysema, chronic bronchitis, or asthma-COPD overlap syndrome (ACOS). For the treatment of patients in the D group, GOLD includes drugs such as roflumilast, but adds an explanation that they can be used when the patient presents cough and expectoration (chronic bronchitis phenotype), and even mentions the preference for using inhaled corticosteroids (ICS) combined with bronchodilators in patients with ACOS or eosinophilia. In fact, it is surprising that ACOS is not included in the treatment scheme, since in 2014, GOLD, in collaboration with the Global Initiative for Asthma (GINA), published a long document on ACOS, which even included therapeutic recommendations.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Up to 20% of patients with COPD may have ACOS, but in GOLD 2017 its presence has been reduced to only a few lines in the whole document.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The new GOLD grid should be welcomed as an attempt to simplify the issue; however, it does not address the real complexity of the disease. The examples of ICS, roflumilast, azithromycin, and mucolytics underline the weaknesses of the new GOLD classification, since these drugs cannot be indicated according to the patient's mMRC or CAT scores, and instead, the phenotypes of patients who will respond to these therapies must be identified<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a>; this is the approach described by GesEPOC. Nor should these drugs be reserved for group D, since they may be needed by some group C patients who, likewise, meet the indications for treatment.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In contrast to GesEPOC, the GOLD gives less attention and therapeutic importance to the evaluation of future risks; only the frequency of previous exacerbations is considered and neither FEV<span class="elsevierStyleInf">1</span> nor multidimensional scales, such as BODE etc., are taken into account.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In addition to the simplification of the grid, GOLD and GesEPOC have also come closer in other areas, such as the reference in GOLD 2017 to treatment with macrolides, the mention of withdrawal of ICS, the use of inhaled antibiotics in bronchiectasis associated with COPD, and palliative or end-of-life care, points that already appeared in the original 2012 version of GesEPOC.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, the differences between the GOLD and GesEPOC classifications of patients as exacerbators or non-exacerbators are clearly reducing, although using the mMRC or the CAT in exacerbators (C or D) is not, in our opinion, useful for identifying the optimal preventive treatment.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Nevertheless, the initial gap between the two proposals is gradually closing.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Perhaps one day differences will be reduced to a mere question of terminology rather than of concepts.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any economic conflicts of interests with regard to this article, but as authors of the GesEPOC guidelines, they do have an intellectual conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of Interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Miravitlles M, Soler-Cataluña JJ. GOLD en 2017: una visión desde la Guía Española de la EPOC (GesEPOC). Arch Bronconeumol. 2017;53:89–90.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017. Available from: <a href="http://goldcopd.org/">http://goldcopd.org</a> [accessed 27.12.16]." ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Vestbo" 1 => "S.S. Hurd" 2 => "A.G. Agustí" 3 => "P.W. Jones" 4 => "C. Vogelmeier" 5 => "A. Anzueto" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201204-0596PP" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2013" "volumen" => "187" "paginaInicial" => "347" "paginaFinal" => "365" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22878278" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New GOLD classification: longitudinal data on group assignment" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "COPD History Assessment In SpaiN (CHAIN) Cohort" "etal" => true "autores" => array:6 [ 0 => "C. Casanova" 1 => "J.M. Marín" 2 => "C. Martínez-González" 3 => "P. de Lucas-Ramos" 4 => "I. Mir-Viladrich" 5 => "B. Cosio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1465-9921-15-3" "Revista" => array:5 [ "tituloSerie" => "Respir Res" "fecha" => "2014" "volumen" => "15" "paginaInicial" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24417879" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differential effect of modified Medical Research Council dyspnea, COPD assessment test, and Clinical COPD Questionnaire for symptoms evaluation within the new GOLD staging and mortality in COPD" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "COPD History Assessment in Spain (CHAIN) Cohort" "etal" => true "autores" => array:6 [ 0 => "C. Casanova" 1 => "J.M. Marín" 2 => "C. Martínez-González" 3 => "P. de Lucas-Ramos" 4 => "I. Mir-Viladrich" 5 => "B. Cosio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.14-2449" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2015" "volumen" => "148" "paginaInicial" => "159" "paginaFinal" => "168" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25612228" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacological treatment of stable COPD" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Spanish COPD guidelines (GesEPOC)" "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.J. Soler-Cataluña" 2 => "M. Calle" 3 => "J. Molina" 4 => "P. Almagro" 5 => "J.A. Quintano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.04.001" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2012" "volumen" => "48" "paginaInicial" => "247" "paginaFinal" => "257" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22561012" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic obstructive pulmonary disease phenotypes. The future of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.K. Han" 1 => "A. Agustí" 2 => "P.M. Calverley" 3 => "B.R. Celli" 4 => "G. Criner" 5 => "J.L. Curtis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200912-1843CC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2010" "volumen" => "182" "paginaInicial" => "598" "paginaFinal" => "604" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20522794" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "Available from: <span class="elsevierStyleInterRef" id="intr0015" href="http://www.goldcopd.org/uploads/users/files/AsthmaCOPDOverlap.pdf">http://www.goldcopd.org/uploads/users/files/AsthmaCOPDOverlap.pdf</span> [accessed 27.12.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis of diseases of chronic airflow limitation: asthma COPD and Asthma-COPD Overlap Syndrome (ACOS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Global Strategy for Asthma Management and the Prevention and the Global Strategy for the Diagnosis" 1 => "Management and Prevention of Chronic Obstructive Pulmonary Disease" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2014" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pharmacological strategies to reduce exacerbation risk in COPD: a narrative review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Miravitlles" 1 => "A. D’Urzo" 2 => "D. Singh" 3 => "V. Koblizek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12931-016-0425-5" "Revista" => array:5 [ "tituloSerie" => "Respir Res" "fecha" => "2016" "volumen" => "17" "paginaInicial" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27613392" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of patients with COPD and recurrent exacerbations: the role of infection and inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Santos" 1 => "A. Marín" 2 => "J. Serra-Batlles" 3 => "D. de la Rosa" 4 => "I. Solanes" 5 => "X. Pomares" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Chron Obst Pulm Dis" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "515" "paginaFinal" => "525" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The differences between GesEPOC and GOLD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.L. Izquierdo Alonso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2016.04.016" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "453" "paginaFinal" => "454" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27344927" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000003/v1_201703240112/S1579212917300204/v1_201703240112/en/main.assets" "Apartado" => array:4 [ "identificador" => "46447" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000003/v1_201703240112/S1579212917300204/v1_201703240112/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300204?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 5 | 14 |
| 2024 October | 38 | 23 | 61 |
| 2024 September | 40 | 14 | 54 |
| 2024 August | 62 | 29 | 91 |
| 2024 July | 36 | 18 | 54 |
| 2024 June | 59 | 22 | 81 |
| 2024 May | 78 | 26 | 104 |
| 2024 April | 31 | 27 | 58 |
| 2024 March | 46 | 21 | 67 |
| 2024 February | 41 | 17 | 58 |
| 2023 March | 12 | 3 | 15 |
| 2023 February | 60 | 23 | 83 |
| 2023 January | 34 | 19 | 53 |
| 2022 December | 40 | 23 | 63 |
| 2022 November | 43 | 31 | 74 |
| 2022 October | 54 | 27 | 81 |
| 2022 September | 27 | 26 | 53 |
| 2022 August | 36 | 52 | 88 |
| 2022 July | 31 | 27 | 58 |
| 2022 June | 32 | 30 | 62 |
| 2022 May | 34 | 40 | 74 |
| 2022 April | 34 | 35 | 69 |
| 2022 March | 39 | 57 | 96 |
| 2022 February | 30 | 29 | 59 |
| 2022 January | 31 | 30 | 61 |
| 2021 December | 31 | 36 | 67 |
| 2021 November | 34 | 47 | 81 |
| 2021 October | 45 | 40 | 85 |
| 2021 September | 33 | 45 | 78 |
| 2021 August | 23 | 35 | 58 |
| 2021 July | 26 | 20 | 46 |
| 2021 June | 42 | 31 | 73 |
| 2021 May | 38 | 39 | 77 |
| 2021 April | 126 | 76 | 202 |
| 2021 March | 44 | 19 | 63 |
| 2021 February | 33 | 25 | 58 |
| 2021 January | 25 | 17 | 42 |
| 2020 December | 33 | 22 | 55 |
| 2020 November | 23 | 21 | 44 |
| 2020 October | 19 | 12 | 31 |
| 2020 September | 29 | 13 | 42 |
| 2020 August | 21 | 12 | 33 |
| 2020 July | 52 | 18 | 70 |
| 2020 June | 21 | 9 | 30 |
| 2020 May | 16 | 13 | 29 |
| 2020 April | 34 | 22 | 56 |
| 2020 March | 21 | 18 | 39 |
| 2020 February | 28 | 23 | 51 |
| 2020 January | 29 | 16 | 45 |
| 2019 December | 39 | 25 | 64 |
| 2019 November | 36 | 21 | 57 |
| 2019 October | 34 | 17 | 51 |
| 2019 September | 24 | 11 | 35 |
| 2019 August | 26 | 23 | 49 |
| 2019 July | 31 | 22 | 53 |
| 2019 June | 26 | 21 | 47 |
| 2019 May | 31 | 26 | 57 |
| 2019 April | 24 | 38 | 62 |
| 2019 March | 33 | 33 | 66 |
| 2019 February | 34 | 13 | 47 |
| 2019 January | 26 | 15 | 41 |
| 2018 December | 36 | 20 | 56 |
| 2018 November | 62 | 26 | 88 |
| 2018 October | 81 | 33 | 114 |
| 2018 September | 52 | 16 | 68 |
| 2018 May | 11 | 1 | 12 |
| 2018 April | 43 | 24 | 67 |
| 2018 March | 34 | 11 | 45 |
| 2018 February | 81 | 25 | 106 |
| 2018 January | 193 | 11 | 204 |
| 2017 December | 187 | 17 | 204 |
| 2017 November | 42 | 24 | 66 |
| 2017 October | 41 | 20 | 61 |
| 2017 September | 31 | 30 | 61 |
| 2017 August | 34 | 37 | 71 |
| 2017 July | 51 | 52 | 103 |
| 2017 June | 74 | 63 | 137 |
| 2017 May | 2 | 1 | 3 |
| 2017 April | 2 | 1 | 3 |
| 2017 March | 1 | 2 | 3 |
| 2017 February | 0 | 3 | 3 |
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