Chronic obstructive pulmonary disease (COPD), a progressive respiratory condition characterized by dyspnea due to airflow limitation, is the fourth leading cause of death worldwide, and its prevalence is expected to increase in the coming decades. Though it is strongly associated with smoking, other causes include air pollution, indoor biomass fuel exposure, and occupational exposure to hazardous gases and dusts. There are also genetic and developmental factors that may predispose a person to developing COPD. The underlying pathophysiology of COPD involves chronic inflammation of the small airways leading to airflow limitation and gas trapping, in conjunction with destruction of the lung parenchyma which impairs gas exchange and promotes CO2 retention. Treatment is primarily aimed at alleviating symptoms, as there are currently few therapies that alter the progressive course of the disease. COPD is commonly associated with multiple medical comorbidities, and patients periodically suffer exacerbations during which symptoms acutely worsen, sometimes requiring emergency care or hospitalization. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides an evidence-based guide for practitioners to diagnose and treat COPD, which is summarized below.
GOLD Criteria for Classifying Disease Severity
Note: Patients with COPD are assigned both a grade and a group
Grade System (1 to 4)
Group System (A to D)
Group System Algorithm for Combined COPD Assessment
Bronchodilators: B2-agonists or Anti-Muscarinics
Inhaled Corticosteroids (ICS)
For Persistent Dyspnea
For Frequent Exacerbations
GOLD Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease, 2020 Report
GOLD Pocket Guide to COPD Diagnosis, Management, and Prevention: A Guide for Health Care Professionals
mMRC (Modified Medical Research Council) Dyspnea Scale
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