GOLD Executive Summary (2005 Update):
Summary of Recommendations

Between January 1 and December 2004, 131 articles met the search criteria. Of these, 8 papers were identified to have an impact on the Executive Summary. Of these, 5 papers confirmed an existing statement and were added as a reference:

1. Page 12: Man WD, Mustfa N, Nikoletou D, Kaul S, Hart N, Rafferty GF, Donaldson N, Polkey MI, Moxham J. Effect of salmeterol on respiratory muscle activity during exercise in poorly reversible COPD. Thorax. 2004 Jun;59(6):471-6.

2. Page 12: O’Donnell DE, Fluge T, Gerken F, Hamilton A, Webb K, Aguilaniu B, Make B, Magnussen H. Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD. Eur Respir J. 2004 Jun;23(6):832-40.

3. Page 13: Oostenbrink JB, Rutten-van Molken MP, Al MJ, Van Noord JA, Vincken W. One-year cost-effectiveness of tiotropium versus ipratropium to treat chronic obstructive pulmonary disease. Eur Respir J. 2004 Feb;23(2):241-9.

4. Page 14: Spencer S, Calverley PM, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J. 2004 May;23(5):698-702.

5. Page 14: Wongsurakiat P, Maranetra KN, Wasi C, Kositanont U, Dejsomritrutai W, Charoenratanakul S. Acute respiratory illness in patients with COPD and the effectiveness of influenza vaccination: a randomized controlled study. Chest. 2004 Jun;125(6):2011-20.

Three papers introduced information that required a new statement to be added to the Executive Summary:

1. Page 14 – Add sentence: Short-term treatment with a combined inhaled glucocorticosteroid and long-acting ß2-agonist resulted in greater control of lung function and symptoms than combined anticholinergic and short-acting ß2-agonist.

Reference: Donohue JF, Kalberg C, Emmett A, Merchant K, Knobil K. A short-term comparison of fluticasone propionate/ salmeterol with ipratropium bromide/albuterol for the treatment of COPD. Treat Respir Med. 2004;3(3):173-81.

2. Page 14 - Change paragraph on immunoregulators to read: Studies using an immunostimulator in COPD show a decrease in the severity and frequency of exacerbations94 (add new reference). However, additional studies to examine the long term effects of this therapy are required before regular use can be recommended (Evidence B).

Reference: Li J, Zheng JP, Yuan JP, Zeng GQ, Zhong NS, Lin CY. Protective effect of a bacterial extract against acute exacerbation in patients with chronic bronchitis accompanied by chronic obstructive pulmonary disease. Chin Med J (Engl). 2004 Jun;117(6):828-34.

3. Page 20 - Add sentence: Early outpatient pulmonary rehabilitation after hospitalization for COPD exacerbation results in exercise capacity and health status improvements at three months.

Reference: Man WD, Polkey MI, Donaldson N, Gray BJ, Moxham J. Community pulmonary rehabilitation after hospitalisation for acute exacerbations of chronic obstructive pulmonary disease: randomised controlled study. BMJ. 2004 Nov 20;329(7476):1209.

A major new segment appears in Chapter 3, Component 4 on antibiotics in treatment of COPD exacerbations (page 21). The material was prepared by the GOLD Science Committee which gratefully acknowledges the opportunity to review a statement on this topic prepared by the European Respiratory Society and provided to the Committee by Dr. William MacNee and Dr. Mark Woodhead. Prior to its release, the material was reviewed by Dr. Sanjay Sethi, State University of New York at Buffalo, Buffalo, New York, and Dr. Antonio Anzueto, University of San Antonio, San Antonio, Texas.

The proposed modifications for the Updated 2005 documents were approved by the GOLD Executive Committee.

An Appendix includes a report on outcome measures for COPD to encourage comments and input from the scientific community to prepare for the full revision of the report, scheduled to appear in mid-2006. The many individuals who participated in preparation of this report are listed in the document. The GOLD Science Committee is grateful to those who contributed to this report, particularly the work of Dr. Paul Jones, London, England and Dr. Alvar Agusti, Palma de Mallorca, Spain.