New treatment options are emerging to tackle chronic obstructive pulmonary disease COPD, while it remains important to be confident in one’s own diagnosis in the current era of powerful bronchodilators.
Our understanding of the common smoking-related lung disease, chronic obstructive pulmonary disease COPD, has improved dramatically over the last 15 years. This is largely the result of the dedicated work carried out by the Global Initiative for Chronic Obstructive Lung Disease GOLD. GOLD is a consortium of clinicians and scientists dedicated to increasing awareness of COPD, developing preventative strategies and improving the management of this condition.
GOLD first reported consensus guidelines in 2001 which were subsequently updated in 2006 and 2011. Many of you will remember the often confusing variety of terms used for the condition such as ‘pink puffer’, ‘blue bloater’, bullous disease, bronchitis, emphysema etc.
One of the first tasks of GOLD was to decide upon a name that incorporated all of the above clinical / radiographic / physiologic terms and to agree a marker for the disease by which one could standardise stage, prognosis and treatment.
The result was the name COPD and the single marker was the flow rate, FEV1 the amount of one’s vital capacity one can exhale in the first second of a forced exhalation manoeuvre. From 2001 until the 2011 guideline, COPD was graded as Stage 1-4 on the basis of predicted FEV1 as measured by spirometry.
The FEV1 is an important indicator of severity of COPD as it essentially measures the cumulative cross sectional area of the tracheobronchial tree and, when reduced, indicates narrowing or obstruction of the airways.
Indeed, the key pathophysiologic abnormality in COPD is progressive airflow obstruction which can be measured as a decline in FEV1 over time.