In November, 2016, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) published its updated strategy for chronic obstructive pulmonary disease (COPD). The new document is the first major alteration to the Global Strategy for the Diagnosis, Management, and Prevention of COPD since 2011, when the ABCD assessment system was introduced. The system was intended to mark the beginning of the process of moving towards patienttailored therapy for COPD. The most important change this year concerns the ABCD criteria.

The new ABCD assessment system separates the assessment of lung function using spirometry from the ABCD grades. Patients will be assigned one of four numbered groups based on FEV1 score (eg, GOLD1), and they will be allocated an ABCD grade solely on the basis of respiratory symptoms and the risk of exacerbations. As previously, the grade will guide pharmacological treatment.

GOLD noted that the “revised assessment tool acknowledges the limitation of FEV1 in influencing some therapeutic decisions for individualised patient care and highlights the importance of patient symptoms and exacerbation risks in patients with COPD”. GOLD emphasised the necessity of spirometry in diagnosis, prognosis, and in deciding upon nonpharmacological therapies.

SUMMARY OF NEW RECOMMENDATIONS