What’s GOLD Got to Do With It?

This article was written by Michael W. Hess, MPH, RRT, RPFT

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is a strong voice in the COPD world. They create a yearly report with all the latest COPD research and treatment recommendations. Many members of the GOLD Science Committee are also part of the COPD Foundation’s Medical and Scientific Advisory Committee. Today, we will take a closer look at GOLD and the impact they have on everyone affected by COPD.

THE EARLY DAYS

Believe it or not, expert panels have been meeting to discuss COPD since the late 1950s. At the time, words like “emphysema,” “chronic bronchitis,” and even “asthma” were used by health care professionals (HCPs) with little consistency or even formal definitions. In 1959, a group of respiratory experts got together to create formal definitions for these problems and suggest future research directions.¹

Unfortunately, not much came of the symposium, and the real burden of COPD was still not very well understood. Because of that, there was little urgency to try and lower that burden. Worse, medical science did not fully grasp all the changes inside the body that lead to COPD. Much of the technology we rely upon today for diagnosis, like spirometers, was not yet common. Some of the diagnostic tools, like CT scanners, had not even been invented yet.

The COPD epidemic continued to grow under the radar for the next four decades. By the late 1990s, COPD was still not top of mind for many in health care, but a new generation of lung health experts knew it was time to act. They encouraged the United States National Institutes of Health (NIH) and the World Health Organization (WHO) to work together and create a new global initiative dedicated to preventing and treating COPD.² That initiative was GOLD.

STRIKING GOLD

The very first GOLD COPD conference was held in 1998. It brought together experts from the respiratory medicine world and areas like public health, epidemiology (the study of outcomes and diseases at the community level), and health education. The experts were split into three working groups. The first of these looked at how COPD should be defined and how it progressed over time. Group two had a big mission. They focused on the causes of COPD and how it should be diagnosed. They also looked at the kinds of damage done to the lungs, and how to measure the damage. The final group focused on ways to manage COPD.

Their work continued over the next two years. The groups met at conferences for the American Thoracic Society and the European Respiratory Society to collect thoughts and opinions from others in the field. Finally, in 2001, the first series of GOLD documents were published. It included an executive summary printed in one of the top science journals, a pocket guide designed for HCPs, and a reference guide for patients and caregivers.

The first GOLD report was a smashing success. The GOLD team realized one of the greatest benefits to the project would be regular community updates. Because of that they built the GOLD Science Committee, made up of key opinion leaders from around the world. Since 2001, the GOLD report has been updated annually with the latest research and best therapy recommendations. The report also had major updates in 2006, 2011, and 2017. These updates added things like considering other problems that happen along with COPD, using quality of life as a sign of how extensive a case of COPD is, and pointing out that COPD is not only caused by smoking.

THE NEW GOLD STANDARD

The 2023 report is another major revision. This latest version shows that COPD can be caused by things like exposure to fumes at work or air pollution at home. It also highlights the need for HCPs to test more people for COPD earlier in their lives, which can help make treatments more effective. Treatment recommendations have been updated to lower the number of exacerbations (symptom flare-ups) that people have and to help them breathe better longer. You can read the latest GOLD publications on the GOLD website. The COPD Foundation will also highlight the new GOLD strategy throughout COPD Awareness Month.

GOLD may not be a household name for people living with COPD, but it can have a big impact on their lives. Without GOLD, our knowledge about the management and prevention of COPD would probably not be as advanced as it is. GOLD helps all of us keep up with the latest advances and evidence for care. With their support and leadership, we will all continue the march to a cure!