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The Gold Rush (figure 1),1 a 1925 classic silent movie by Chaplin, depicted him in his trademark little tramp character as a lone prospector searching for the precious metal somewhere in Alaska. On 16 November 2011, the release of the current revision of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) Executive Summary in Shanghai, China,2 just recently published elsewhere,3 gave way to a new rush, the GOLD rush. Clinical guidelines need to be updated regularly to implement some of the vast knowledge about chronic obstructive pulmonary disease (COPD) accumulated over the last years, and to assess implementation and adherence. This second 5-year revision of the GOLD strategic document has somewhat shaken the COPD world for good.
The GOLD authors presented a new classification of COPD which intended to provide a better understanding of the impact of the disease on an individual patient than spirometry-only COPD staging, by collapsing four spirometry categories into just two, and adding exacerbations and symptoms. This is a three-dimensional patient evaluation, as previously suggested by Lopez-Campos.4 A new classification with four groups (ABCD) was proposed, although GOLD might not have plucked stuff out of the air, and might have made an attempt to validate this ABCD system before it was included in their strategic document. So, investigators have raced to quantify the distribution of their own cohorts of patients according to these new COPD categories, also used …
- Chronic obstructive pulmonary disease