GOLD COPD Guideline 2024

Question 1

Definition and diagnostic criteria of COPD

Answer 1

Heterogenous lung condition with (symptoms + structural damage + outcome):
1. Chronic respiratory symptoms (dyspnoea, cough, sputum production, exacerbation)
2. Due to airway abnormalities (bronchitis, bronchiolitis) and/or alveoli (emphysema)
3. Causing persistent, progressive airflow obstruction

Spirometry - non-fully reversible airway obstruction post-bronchodilation
- FEV1 / FVC < 0.7

Special considerations to patients not fulfilling criteria:
A. Pre-COPD or PRISM (preserved ratio impaired spirometry)
- Normal FEV1/FVC ratio but with other abnormal spirometry results (low FEV1, low DCO)

Question 2

Causes and risk factors of COPD

Answer 2

Genetics (G) + Environment (E) + lifetime (T) exposure (GETnomics)

1. Tobacco smoking
2. Toxic particles and gases, pollution
3. Abnormal lung development/accelerating lung aging
4. Alpha-1-antitrypsin deficiency (SERPINA-1 gene)

Question 3

Clinical presentation of COPD

Answer 3

1. Asymptomatic
2. Dyspnoea and wheeze, chest tightness, fatigue
3. Progressive activity limitations
4. Sputum production
5. Acute exacerbation due to illness or exposure

Question 4

Spirometry - FEV1 in adulthood
- Predisposing: birthweight, growth failure (abnormal lung growth)
- Precipitating: accelerated decline

Answer 4

1. Birthweight and childhood disadvantage factor
   - Lower birthweight leads to lesser FEV1 since childhood
   - Higher birthweight can achieve supranormal FEV1
2. Growth failure and abnormal lung growth
   - Growth failure and failure of lung to reach maturity and full FEV1
   - Adolescents with catch up growth may achieve full lung growth, maturity and FEV1
   –> 50% develop COPD due to abnormal lung growth and development
3. Accelerated decline - due to environment exposure (50%)