2023年GOLD慢性阻塞性肺疾病诊断、管理及预防全球策略更新要点解读

Updated Key Points Interpretation of Global Strategy for the Diagnosis,Management,and Prevention of Chronic Obstructive Pulmonary Disease(2023 Report)

2023年慢性阻塞性肺疾病全球倡议(GOLD)维持了2022年的基本框架,但在慢性阻塞性肺疾病(以下简称慢阻肺)定义、评估、初始治疗和随访期管理等方面进行了较大修订,主要包括:(1)第1章定义和概述部分被重写,提出慢阻肺新定义,纳入慢阻肺新的背景信息、治疗策略和分类,新增慢性支气管炎的内容;(2)第2章诊断和评估部分增加慢阻肺筛查和病例发现的相关内容,将ABCD评估工具修订为ABE评估工具(即慢阻肺急性加重高风险人群不再根据症状水平进一步分组),更新影像学和计算机断层扫描(CT)信息;(3)第3章预防和维持治疗部分更新了肺炎链球菌疫苗接种建议,新增了降低慢阻肺死亡率的干预措施的信息,更新吸入制剂递送相关问题,新增吸入药物依从性的内容,更新了远程康复相关证据,扩充了慢阻肺介入和手术治疗的内容;(4)第4章慢阻肺稳定期管理部分新增吸入装置选择的内容,更新了初始药物治疗和随访期药物治疗的信息;(5)第5章慢阻肺急性加重管理部分提出慢阻肺急性加重的新定义和一套新参数以评估慢阻肺急性加重严重程度,扩展了慢阻肺急性加重鉴别诊断的内容;(6)第6、7章根据最新证据更新了关于慢阻肺与合并症、慢阻肺与新型冠状病毒感染的内容。以上更新对慢阻肺的临床诊疗具有重要的指导意义。

Global Strategy for the Diagnosis,Management,and Prevention of Chronic Obstructive Pulmonary Disease(2023 Report)(GOLD 2023)maintains the basic framework of GOLD 2022,but with major revisions in the definition,assessment,initial therapy and follow-up management of chronic obstructive lung disease(COPD)as follow:(1)Chapter 1:The definition and overview section was rewritten to propose a new definition of COPD,incorporating new background information,therapeutic strategies and classifications for COPD,with the addition of content on chronic bronchitis;(2)Chapter 2:Content on screening and case-finding of COPD has been included,the ABCD assessment tool has been revised to the ABE assessment tool(no further grouping of high-risk population of acute exacerbation of COPD based on symptom levels),information on imaging and computed tomography scans(CT)has been included in the diagnosis and assessment section;(3)Chapter 3:Recommendations for Streptococcus pneumoniae vaccination have been updated,information on therapeutic interventions to reduce COPD mortality has been included,issues related to inhalation delivery have been updated,content on inhaled medications adherence and remote rehabilitation has been included,information on interventional and surgical therapies of COPD has been expanded in the prevention and maintenance treatment section;(4)Chapter 4:Information on the selection of inhalation devices has been included,information on initial drug therapy and follow-up drug therapy has been updated in the management of stable COPD section;(5)Chapter 5:A new definition of and set of acute exacerbation of COPD assessment parameters have been proposed,information on differential diagnoses of acute exacerbation of COPD has been expanded in the acute exacerbation of COPD section management;(6)Chapter 6 and 7:Updating content on COPD and complications(Chapter 6),COPD(Chapter 7)and COVID-19 based on the latest evidence.The above updates will be an important guide to the clinical management of COPD.