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8/13/2019 GOLD Guidelines2009

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executive summary


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EXECUTIVE SUMMARYuPDateD 2009

GLOBaL strateGy FOr tHe DiaGNOsis, maNaGemeNt,aND PreveNtiON OF cHrONic OBstructive PuLmONary Disease

2009 Medical Communications Resources, Inc.

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GOLD EXECUTIVE COMMITTEE*

Roberto Rodriguez Roisin, MD, ChairUniversity of BarcelonaBarcelona, Spain

Antonio Anzueto, MD, Vice Chair(Representing American Thoracic Society)University of Texas Health Science CenterSan Antonio, Texas, USA

Jean Bourbeau, MDMcGill University Health CentreMontreal, Quebec, Canada

Peter Calverley, MDUniversity Hospital AintreeLiverpool, England, UK

Teresita S. deGuia, MDPhilippine Heart Center

Quezon City, Philippines

Yoshinosuke Fukuchi, MD(Representing Asian Pacific Society for Respirology)Tokyo, Japan

David S.C. Hui, MDThe Chinese University of HongHong Kong, ROC

Christine Jenkins, MDWoolcock Institute of Medical ResearchSydney NSW, Australia

Ali Kocabas, MDCukurova University School of MedicineAdana, Turkey

Fernando Martinez, MDUniversity of Michigan School of MedicineAnn Arbor, Michigan, USA

Mara Montes de Oca, MD, PhD(Representing Latin American Thoracic Society)Central University of VenezuelaLos Chaguaramos, Caracas, Venezuela

Chris van Weel, MD(Representing the World Organization of Family Doctors)University of NijmegenNijmegen, The Netherlands

Jorgen Vestbo, MDHvidovre University Hospital, Hvidore, Denmarkand University of ManchesterManchester, UK

Ob"+/"+:Mark Woodhead, MD(Representing European Respiratory Society)Manchester Royal InfirmaryManchester England, UK

GOLD SCIENCE COMMITTEE*

Jorgen Vestbo, MD, ChairHvidovre University HospitalHvidore, Denmark and

University of ManchesterManchester, England, UK

Peter Calverley, MDUniversity Hospital AintreeLiverpool, England, UK

A. G. Agusti, MDHospital University Son DuretaPalma de Mallorca, Spain

Antonio Anzueto, MDUniversity of Texas Health Science CenterSan Antonio, Texas, USA

Peter J. Barnes, MD

National Heart and Lung InstituteLondon, England, UK

Marc Decramer, MDUniversity HospitalsLeuven, Belgium

Leonardo M. Fabbri, MDUniversity of Modena&ReggioEmiliaModena, Italy

Yoshinosuke Fukuchi, MDTokyo, Japan

Paul Jones, MDSt George's Hospital Medical SchoolLondon, England, UK

Fernando Martinez, MDUniversity of Michigan School of MedicineAnn Arbor, Michigan, USA

Klaus F. Rabe MD, PhDLeiden University Medical CenterLeiden, The Netherlands

Roberto Rodriguez-Roisin, MDUniversity of BarcelonaBarcelona, Spain

Donald Sin, MD

St Paul's HospitalVancouver, Canada

Jadwiga A. Wedzicha, MDUniversity College LondonLondon, England, UK

G'*b' s+"$ #*+ %" D&$*&, m$"", ! P+"/"&* *#c%+*& Ob+.&/" P.'*+ D&"" (UPDATED 2009)

*D? ?= ? GD C?== @? ? GD ,===..


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GGIJ KF J=271,272, F@E@E IFEF@KFIJ N@K@==IEK E@JJ E LIK@FEJ F= K@FE P@EIJ K I F= IFEF@K@FE =FI HL@MEK FIJJI J@ ==KJ286. !FI OG, F@EK@FE F= JFIK-K@E 2-FE@JK E E EK@F@EI@ GIFLJIKI E FI JLJK@E @GIFMEKJ @E !1 KE@KI IL FE E FJ EFK GIFL M@E F=KPGPO@J FMI 90 PJ F= KIKEK112-114 (E A).

F@EK@FE F= 2-FE@JK, E EK@F@EI@, E/FI KFGP@E P GIFL @K@FE @GIFMEKJ @ELE =LEK@FE112-118 E K JKKLJ112,119. EIJ@E KELI F= ILJ LJLP @EIJJ FJKJ, E EHL@MEK E=@K P FLI P @EIJ@E K FJ F=FE IFEF@KFI NE J@ ==KJ I EFK @@K@E=KFI. DK@ JJJJEKJ F= K@J GGIF M EFKE II@ FLK.

11

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DFJ-IJGFEJ IK@FEJ@GJ LJ@E K !1 J KFLKF I IK@MP =K N@K JJJ F= IFEF-@KFIJ98-101. FO@@KP @J JF FJ IK. EIJ@E KFJ F= @KI 2-FE@JK FI E EK@F@EI@ P EFII F= E@KL, JG@P NE @ME P EL@QI, GGIJ KF GIFM@ JLK@M E=@K @E LKG@JFJ120 (E B) LK @J EFK EJJI@P G=L @EJK @JJ121 (E C).

E KIKEK @J @ME P K @E IFLK, KKEK@FE KF==K@M IL @MIP E KI@E@E @E @EI KE@HL @JJJEK@278. F@ F= @EI M@ N@ GE FEM@@@KP, FJK, K GIJI@@E GPJ@@E, E K J@JE @@KP F= K GK@EK. C+D GK@EKJ P M FIGIFJ @E ==K@M FFI@EK@FE E =@E @K II KFLJ J@G KI-FJ @EI (D) KE F KPMFLEKIJ FI PFLEI JKK@J. K @J JJEK@ KF

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EJLI KK @EI KE@HL @J FIIK E KF I-K@J K M@J@K.

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(E A). BJ FE J@E I JKLP F= GK@EKJN@K !1 JJ KE 60% ILI KIKEK N@K @ELFFIK@FJKIF@J E IJ K IK F= @E F=LE =LEK@FE289 (E B). LI KIKEK N@K@E LFFIK@FJKI@FJ J E JFNE KF ILK =IHLEP F= OIK@FEJ E KLJ @GIFM KJKKLJ127 =FI JPGKFK@ C+D GK@EKJ N@K E !1 6.7 + (50 #), EJFEIP GLFEIP PGIKEJ@FE189,190.

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15


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G@IFKIP E +!. ME J@G JG@IFKI@ KJKJE @==@LK =FI J@ GK@EK KF GI=FI GIFGIP.J JLIEKJ I EFK LIK LI@E E LKOIK@FE; KI=FI K@I IFLK@E LJ @J EFK IFE.

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17


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A IE F= I@KI@ KF FEJ@I =FI FJG@K JJJJEK/@JJ@FE =FI OIK@FEJ F= C+D I JFNE @EF@= 10. F GK@EKJ E @@K @JJ@FE KFE @EKEJ@M I LE@K (C) (F@= 11). A@JJ@FE F=GK@EKJ N@K JMI C+D OIK@FEJ KF @EKI@KFI JG@ IJG@IKFIP I LE@KJ P GGIFGI@K @=GIJFEE, J@J, E HL@GEK O@JK KF @EK@=P EE LK IJG@IKFIP =@LI JLJJ=LP.

=@IJK K@FEJ NE GK@EK IJ K IEPGIKEK I KF GIFM@ JLGGEK FOPE KIGPE KF KI@E NKI K OIK@FE @J @= KIK-E@E. = JF, K GK@EK JFL @KK KF K C@@KP. KIN@J, K GK@EK P E @E

K IEP GIKEK FI FJG@K (F@= 12).

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M FNI FIK@KP E IL EK F= FJG@K JKP=FFN@E @JJ@FE =FI LK C+D [email protected] E @@K K JLGGFIK K @JI I@KI@@JK @E F@= 15. F@= 16 GIFM@J @KJ KF @EL@E =FFN-LG JJJJEK 4 KF 6 NJ =KI @JI=IF K FJG@K. I=KI, =FFN-LG @J K J J=FI JK C+D, @EL@E JLGIM@J@E JF@E JJK@FE,FE@KFI@E K ==K@MEJJ F= IL KIKEK, EFE@KFI@E EJ @E JG@IFKI@ GIKIJ229. +I@FIFJG@K @JJ@FE, FI LFFIK@FJKIF@J, LJ F= FEKI FOPE KIGP, GFFI K IK HL@KP F= @=,E F= IFLK@E GPJ@ K@M@KP M E =FLE KF GI@K@M F= I@JJ@FE282. #F M@J@KJ P FL-

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GGFIKLE@K@J =FI GIMEK@FE F= =LKLI OIK@FEJJFL IM@N =FI @JI, N@K GIK@LIKKEK@FE KF JF@E JJK@FE, LIIEK M@EK@FE(@E=LEQ, GELFF M@EJ), EFN F= LIIEKKIGP @EL@E @EI KE@HL32,262,263, E FN KFIFE@Q JPGKFJ F= OIK@FEJ. +IFKIGPEFNE KF IL K ELI F= OIK@FEJ EFJG@K@QK@FEJ E P K K@ F= =@IJK/EOKFJG@K@QK@FE, JL J FE-K@E @E IFEF@KFIJ,@E LFFIK@FJKIF@J, E F@EK@FE @EIJ,JFL JG@=@P FEJ@I. F@ GIFJJFL @JLJJ E GI@E@G I@MIJ @EK@=@@= K GK@EK J J@E@=@EK GIJ@JK@E @J@@KP.

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215. LI C, L-@@ , !IE B, FI@LQ D, LQ NFI A, ? 7. LJ F= B-EKI@LIK@ GGK@ @E KEEK F= IP GK@EKJ N@K LK PJGE.J I?= M2005;258:77-85.

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217. CJJ A, IFFJKIJ , "I@-API@ , F ,#IEEQ C, AFEJF A, +FQF !, FF +, AEKF, FI@LQ-F@J@E , DII ; IJ F= KC#C +IFK. EKIK I GIMEKJ FJG@K@J-K@FEJ =FI OIK@FEJ @E C+D GK@EKJ. E@= $>= J2006 L;28(1):123-30.

218. FF C, FFE , "FE , IK@E , "I@EI D,"IEJKFE A, ? 7. +K@EKJ' E IIJ' GI=IEJ@E KNF FJ F= I =FI LK OIK@FEJ F= C+D:IJLKJ F= IEF@J FEKIF KI@. =2002;57(2):167-9.

219. NIJ , CFE ", NIJ@ , C, BLJ D+II , ? 7. EF@Q FEKIF KI@ F= JLGGFIK@JI @E GK@EKJ N@K OIK@FEJ F= IFE@

FJKILK@M GLFEIP @JJ. =2000;55(11):907-12

220. #IEEQ C, CJJ A, JII@ , AFEJF , +L@-LEFP , !IIIF , ? 7. #F FJG@K@JK@FE F=OIK IFE@ FJKILK@M GLFEIP @JJGK@EKJ. E@= $>= J2003;21(1):58-67.

221. FGJFE #, @JFE C+, CIMF +, CIE B,CIFNP . CFEKIF KI@ F= FI GIE@JFE @E FLKG-K@EKJ N@K LK C+D [email protected] J $>= C=?C= M1996;154(2 +K 1):407-12.


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222. DM@J , AELJ , CMIP +. I FIK@FJKIF@J@E GK@EKJ @KK KF FJG@K N@K OIK@FEJ F=IFE@ FJKILK@M GLFEIP @JJ: GIFJGK@MIEF@J FEKIF KI@. L?1999;354(9177):456-60.

223. @NFEI D, IE , DLGI #, CF@EJ D,"IFJJ , @K , ? 7. ==K F= JPJK@ LFFIK@F@JFE OIK@FEJ F= IFE@ FJKILK@M GLFEIP

@JJ. DGIKEK F= KIEJ A==@IJ CFFGIK@MKLP "IFLG. E7 J M1999;340(25):1941-7.

224. K@J !, JK@E@ , BFLIL , FEE AB, HLK, #FE , ? 7. CFGI@JFE F= EL@Q LJFE@E FI GIE@JFFE N@K GF @E K KIKEK F=LK OIK@FEJ F= IFE@ FJKILK@M GLFEIP@JJ: IEF@Q FEKIF [email protected] J $>= C=?C= M2002;165(5):698-703.

225. AIFE D, EE , #IK +, DJ , K@ ",AL , ? 7. LKGK@EK FI GIE@JFE =KI IEPKIKEK F= IFE@ FJKILK@M GLFEIP @JJ. E7 J M2003;348(26):2618-25.

226. FI@LQ-F@J@E . C+D [email protected]: E-

EK. =2006;61(6):535-44.227. CFEEFIJ A!, I., DNJFE , FJ C, #II !, I.,

DJ@EJ , !LIJFE , ? 7. LKFJ =FFN@ELK OIK@FE F= JMI IFE@ FJKILK@M LE@JJ. ++ @EMJK@KFIJ (KLP KFEIJKE +IFEFJJ E +I=IEJ =FI LKFJE @JJ F= IKEKJ).A J $>= C=? C= M1996;154(4 +K 1):959-67.

228. GGI , #INFF D, "IP A, JJP , FIE +.EF@J FEKIF KI@ FGI@E FJG@K K FI N@K @EGK@EK FJG@K I. : FJK @E@@JK@FEEPJ@J. BMJ1998;316(7147):1791-6.

229. "IM@ #, A-NJ A, CFKKFE , !E@E , IN@E A,KMEJFE D. #F KIKEK F= OIK@FEJ F=IFE@ FJKILK@M GLFEIP @JJ P E LKIJG@IKFIP JJJJEK JIM@. L?1998;351(9119):1853-5.

230. FIJKIF , FLJ@EEK +, L=E . K EFJK ==KJ F= JLJK@KLK@E F I =FI @EGK@EK LKI: IM@N F= K M@E. CMAJ1999;160(8):1151-5.

231. K@FE EJK@KLK =FI C@E@ OE (C). CIFE@FJKILK@M GLFEIP @JJ. K@FE @E@ L@@EFE EEK F= IFE@ FJKILK@M GLFEIP @JJ@E LKJ @E GI@IP E JFEIP I. =2004;59LGG 1:1-232.

232. BII A, PJ A, F , FEKJIIK , EI+D, FI@LQ-F@J@E . ==K F= @EKIMEFLJP @E@J-

KI @EFGP@E FE MEK@K@FE/GI=LJ@FE @EHL@KPLI@E IFMIP =IF OIK@FEJ F= IFE@ FJKILK@MGLFEIP @JJ.A $ $>= D>1992;145(6):1328-33.

233. FE , LG@J A, #FI , @ DA, +KIJFEA, FF , ? 7. FGP@E =FI @IIMIJ@ IFE@@I=FN @@KK@FE: IEF@Q JKLP FGI@E E F= 1KI@J KF JKEI GIK@. C>?1999;115(1):38-48.

234. FIJ +, @J , FEKJIIK , II , CG@JKF, +@F C, ? 7. ==K F= KI @==IEK IFEF@KFIJLI@E E

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