Gold Executive Summary of Global Initiative for Chronic Obstructive Lung Disease 2023 Report

A study in Journal of The Pan African Thoracic Society (JPATS) published by Scientific Scholar presents an executive summary of this GOLD 2023 report that summarizes aspects that are relevant from a clinician´s perspective and updates evidence published since the prior executive summary in 2017.

The definition of a disease should only include the characteristics that distinguish it from other diseases. Accordingly, GOLD 2023 proposes a new definition of COPD that, at variance with previous documents, focuses exclusively on these characteristics, separately from its epidemiology, causes, risk factors and diagnostic criteria.

GOLD 2023 defines COPD as a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, expectoration and/or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction.

Factors like cigarette smoking is a key environmental risk factor for COPD. Cigarette smokers have a higher prevalence of respiratory symptoms and lung function abnormalities, a greater COPD mortality rate than non-smokers; yet fewer than 50% of heavy smokers develop COPD.

Occupational exposures, including organic and inorganic dusts, chemical agents, and fumes, are an under-appreciated environmental risk factor for COPD.

Air pollution, which typically consists of particulate matter, ozone, oxides of nitrogen or sulfur, heavy metals, and other greenhouse gases, is a major worldwide cause of COPD, responsible for ~50% of the attributable risk for COPD. Genetic factors like are the most relevant risk factor for COPD identified are mutations in SERPINA1, leading to α-1 antitrypsin deficiency, a major circulating inhibitor of serine proteases.

The lungs grow and mature until about 20-25 years of age (earlier in females), when lung function reaches its peak. This is followed by a relatively short plateau and a final phase of mild lung function decline due to physiological lung aging. Lung diseases are common in both males and females.

Many different studies have reported that asthma and atopy in infancy may be a significant risk factor for COPD in adulthood. Severe lung infections in childhood have been associated with reduced lung function and increased respiratory symptoms in adulthood.

Therefore, it was noted that COPD is a common, preventable, and treatable disease, but extensive under-diagnosis and misdiagnosis leads to patients receiving no treatment or incorrect treatment. The realization that environmental factors other than tobacco smoking can contribute to COPD, that it can start early in life and affect young individuals, and that there are precursor conditions opens new windows of opportunity for its prevention, early diagnosis, and prompt and appropriate therapeutic intervention.

Reference: Agustí A, Celli BR, Criner GJ, Halpin D, Anzueto A, Barnes P, et al. Global initiative for chronic obstructive lung disease 2023 report: gold executive summary. J Pan Afr Thorac Soc 2023;4:58-80.