GOLD v LLN    Page 1

The Global Initiative for Obstructive Lung Disease, GOLD, has set out to raise clinical interest in the diagnosis and management of chronic obstructive pulmonary disease across the world [1] with the aim "to improve prevention and treatment of this lung disease". The GOLD organisation was initially a committee of respiratory specialists which was sponsored by 14 pharmaceutical companies with an interest in respiratory medical practice. It was set up in 1997 with the collaboration of the National Heart, Lung, and Blood Institute, National Institutes of Health, USA, and the World Health Organization

The GOLD Committee arbitrarily defined COPD on clinical and physiological criteria that have been argued to be not based on scientific evidence [2]. The GOLD definition is that COPD should be considered in any patient with symptoms of cough, sputum production, or dyspnoea, and/or a history of exposure to risk factors for the disease. The diagnosis is then confirmed by spirometry showing evidence of airflow limitation. GOLD state that a post bronchodilator FEV1/FVC of < 0.7 confirms the presence of airflow limitation that is not fully reversible.

The GOLD approach has been followed in the UK by the National Institute for Health and Clinical Excellence (NICE) setting out guidelines for the management of COPD [3] indicating that any patient over the age of 35 with a risk factor for COPD and presenting with exertional breathlessness, chronic cough, regular sputum production, frequent winter bronchitis or wheeze should have the diagnosis confirmed by spirometry.

There are two reasons to question the GOLD definition of airflow limitation.

  • Using FEV1/FVC of < 0.7 to define the presence of airflow obstruction is wrong.
  • Using percent of predicted values for FEV1 to define levels of abnormality of lung function introduces age, sex and height bias.

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