Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019

Abstract

Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.

Conflict of interest statement

Conflict of interest: D. Singh reports grants and personal fees from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Chiesi, Glenmark, Menarini, Mundipharma, Novartis, Pfizer, Pulmatrix, Therevance and Verona, personal fees from Cipla, Genentech and Peptinnovate, outside the submitted work. Conflict of interest: A. Agusti reports personal fees from AstraZeneca, Chiesi and Nuvaira, grants and personal fees from Menarini and GlaxoSmithKline, outside the submitted work. Conflict of interest: A. Anzueto reports grants and personal fees for consultancy from GlaxoSmithKline, personal fees for consultancy from AstraZeneca, Novartis, Boehringer Ingelheim and Sunovion Pharmaceutical, outside the submitted work. Conflict of interest: P.J. Barnes reports grants and personal fees from AstraZeneca and Boehringer Ingelheim, personal fees from Pieris, Novartis and Teva, outside the submitted work. Conflict of interest: J. Bourbeau reports grants from CIHR, Canadian Respiratory Research Network (CRRN), Foundation of the MUHC and Aerocrine, personal fees for consultancy and lecturing from the Canadian Thoracic Society and CHEST, grants and personal fees for advisory work and lecturing from AstraZeneca, Boehringer Ingelheim, Grifols, GlaxoSmithKline, Novartis and Trudell, outside the submitted work. Conflict of interest: B.R. Celli reports grants and research support from AstraZeneca, personal fees for consulting and scientific committee membership from GlaxoSmithKline, personal fees for consulting from Boehringer Ingelheim, Novartis, Sanofi-Aventis and Menarini, outside the submitted work. Conflict of interest: G.J. Criner reports grants and personal fees from GlaxoSmithKline, Boehringer Ingelheim, Chiesi, Mereo, AstraZeneca, Pulmonx, Pneumrx, Olympus, Broncus, Lungpacer, Nuvaira, ResMed, Respironics and Patara, personal fees from Verona, BTG, EOLO and NGM, grants from Alung, Fisher Paykel and Galapagos, outside the submitted work. Conflict of interest: P. Frith reports non-financial support to attend a scientific committee meeting from Global Initiative for Chronic Obstructive Lung Disease (GOLD), during the conduct of the study; personal fees for advisory board membership from AstraZeneca, personal fees and non-financial support for advisory board work, chairing independent conference organising committees and lecturing from Boehringer Ingelheim and Novartis, non-financial support for attending educational meetings from GlaxoSmithKline, non-financial support for attending committee and board meetings from Lung Foundation Australia (LFA), personal fees and non-financial support for advisory board work from CSL Behring, outside the submitted work. Conflict of interest: D.M.G. Halpin reports personal fees and non-financial support from Boehringer Ingelheim and Novartis, personal fees from AstraZeneca, Chiesi, GlaxoSmithKline and Pfizer, outside the submitted work. Conflict of interest: M. Han reports personal fees from GlaxoSmithKline, Boehringer Ingelheim and AstraZeneca, research support from Novartis and Sunovion, outside the submitted work. Conflict of interest: M.V. López Varela has nothing to disclose. Conflict of interest: F. Martinez reports personal fees for organising CME programmes and non-financial support for travel from the American College of Chest Physicians, Continuing Education, Inova Fairfax Health System, MD Magazine, Miller Communications, National Association for Continuing Education, PeerView Communications, Prime Communications, Puerto Rican Respiratory Society, Potomac, University of Alabama Birmingham, Physicians Education Resource and Canadian Respiratory Network, personal fees for advisory board and steering committee work, and lecturing, and non-financial support for travel from AstraZeneca, personal fees for advisory board and data safety and monitoring board work, and lecturing, non-financial support for travel from Boehringer Ingelheim, non-financial support for advisory board work from ProterrixBio, personal fees for organising CME programmes from Columbia University Integritas, Methodist Hospital Brooklyn, New York University, UpToDate, WebMD/MedScape, Western Connecticut Health Network, Academic CME, PlatformIQ, Rockpointe, Rare Disease Healthcare Communications and France Foundation, personal fees for advisory board work and non-financial support for travel from ConCert, Roche, Sunovion, Theravance and Teva, personal fees for advisory board and data safety and monitoring board work and non-financial support for travel from Genentech, personal fees for advisory board, steering committee and data safety and monitoring board work, and lecturing, and non-financial support for travel from GlaxoSmithKline, personal fees for advisory board work and lecturing, and non-financial support for travel from Novartis and Chiesi, personal fees for advisory board and steering committee work, and non-financial support for travel from Pearl Pharmaceuticals, personal fees for teleconference involvement from Unity, non-financial support for steering committee work from Afferent/Merck, Gilead, Veracyte, Prometic, Bayer and ProMedior, non-financial support for teleconferencing and steering committee work from Nitto, personal fees for consultancy and steering committee work from Patara, non-financial support for data safety and monitoring board work and steering committee from Biogen, personal fees for advisory board work and support for meeting attendance from Zambon, personal fees for editorial board work from the American Thoracic Society, grants from NIH (IPF UO1, COPD UO1/RO1), and non-financial support for consultancy from Bridge Biotherapeutics, outside the submitted work. Conflict of interest: M. Montes de Oca has nothing to disclose. Conflict of interest: A. Papi reports grants, personal fees for board membership, consultancy, lecturing and travel reimbursement from Chiesi, AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim, Mundipharma and Teva, grants, personal fees for lecturing and travel reimbursement from Menarini, personal fees for lecturing and travel reimbursement from Novartis, Zambon and Sanofi, outside the submitted work. Conflict of interest: I.D. Pavord reports personal fees for lecturing, advisory board work and travel expenses from AstraZeneca, GlaxoSmithKline, Boehringer Ingelheim and Teva, grants and personal fees for lecturing, advisory board work and travel expenses from Chiesi, personal fees for advisory board work from Sanofi/Regeneron, Merck, Novartis, Knopp and Roche/Genentech, personal fees for lecturing from Circassia and Mundipharma, grants and personal fees for advisory board work from Afferent, outside the submitted work. Conflict of interest: N. Roche reports grants and personal fees from Boehringer Ingelheim, Novartis and Pfizer, personal fees from Teva, GlaxoSmithKline, AstraZeneca, Chiesi, Mundipharma, Sanofi, Sandoz, 3M and Zambon, outside the submitted work. Conflict of interest: D.D. Sin reports grants from Merck, personal fees for advisory meetings from Sanofi-Aventis and Regeneron, grants and personal fees for lecturing and advisory board work from Boehringer Ingelheim and AstraZeneca, personal fees for lecturing and advisory board work from Novartis, outside the submitted work. Conflict of interest: R. Stockley reports personal fees for advisory board membership and lecturing from AstraZeneca, personal fees for advisory board membership from MedImmune, Almirall, Kamada, Baxter, Chiesi and Polyphor, personal fees for lecturing from Nycomed, Takeda and GlaxoSmithKline, personal fees for advisory board membership, lecturing and travel to meetings from Boehringer Ingelheim, grants and personal fees for advisory board membership, lecturing and travel to meetings from CSL Behring, outside the submitted work. Conflict of interest: J. Vestbo reports personal fees for consultancy and lecturing from GlaxoSmithKline, Chiesi Pharmaceuticals, Boehringer Ingelheim, Novartis and AstraZeneca, grants from Boehringer Ingelheim, outside the submitted work. Conflict of interest: J.A. Wedzicha reports grants and travel expenses from GlaxoSmithKline, Boehringer Ingelheim, Novartis and AstraZeneca, and grants from Johnson and Johnson, and Chiesi, outside the submitted work. Conflict of interest: C. Vogelmeier reports personal fees from Almirall, Cipla, Berlin-Chemie/Menarini, CSL Behring and Teva, grants and personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Grifols, Mundipharma, Novartis and Takeda, grants from German Federal Ministry of Education and Research (BMBF) Competence Network Asthma and COPD (ASCONET), Bayer Schering Pharma AG, MSD and Pfizer, outside the submitted work.

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