What is (and what is not) a COPD exacerbation: thoughts from the new GOLD guidelines

During November 2006 an updated version of the World Health Organisation/US National Heart Lung and Blood Institute global initiative for chronic obstructive lung disease (GOLD) guideline was made available online.¹ We applaud those involved in creating a living document which has done much to raise the profile of this devastating disease. For many years chronic obstructive pulmonary disease (COPD) was a neglected condition, but research output is now considerable and there have been many developments in the 5 years since the first GOLD report of 2001.² It is widely appreciated that these include an increased understanding of the pathobiology of COPD and the availability of new agents in our evidence-based therapeutic armamentarium. So what else is new in the 2006 GOLD update?

First, and perhaps most importantly, the definition of COPD and the staging classification have been revised. COPD is now defined as a “preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterised by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases”.¹ Although somewhat lengthy, this change of emphasis reflects an admirable attempt to dispel therapeutic nihilism with the …