LAUSR

Every 5 years, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) publishes a major revision of their global strategy for the diagnosis, treatment and prevention of COPD. The latest revision undertaken in 2011 introduced the ABCD multidimensional evaluation. This was a more comprehensive approach to the disease that considered not only airflow limitation determined by spirometry, but also the impact of symptoms, while underlining the importance of preventing exacerbations. The recently published strategy update1 incorporates several significant changes compared to previous editions, and focuses on a new concept of COPD. It is also interesting to see that SEPAR member, Dr Álvar Agustí, Director of the Respiratory Institute at Hospital Clinic in Barcelona, was appointed Chair of the GOLD Board of Directors in September 2016. With this article, we hope to provide a structured illustration of the most important changes that appear in the new GOLD 2017.2 1. Definition and overview: A new definition of the disease is given, underlining the importance of symptoms and the fact that alveolar involvement is not always associated with airway involvement. “Inflammatory response” has also been deleted from the definition, although it is mentioned as a pathophysiological factor. New information is included in this chapter on the pathophysiology and natural history of the disease. The description of abnormal lung development featured in previous editions has been expanded in the new revision, and the different trajectories of lung function over time, expressed as FEV1, leading to the development of COPD, are described. Other factors discussed include exposure to inhaled toxins, host factors, such as genetic abnormalities, that predispose to development of the disease, and abnormal lung development (during gestation or childhood). The possibility that a patient may have COPD without showing accelerated decline in lung function has been accepted. 2. Diagnosis and initial evaluation: The current version maintains the ABCD schematic, but spirometric assessment has been