The board of directors of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recently published an editorial urging that more serious action be taken to better manage chronic obstructive pulmonary disease (COPD). Specifically, the board appealed to both government and nongovernment organizations, the United Nations, and the World Health Organization (WHO) to appropriately recognize the burden of the disease and set forth policies and practices to combat its devastating effects.

The GOLD board makes the case that COPD should no longer be seen as a condition solely related to smoking. Biomass fumes and air pollution are also significant risk factors for adults, and now there is solid evidence that poor prenatal and postnatal lung growth as a result of exposure to pollutants, malnutrition, or infection can also lead to COPD.

In September 2018, the GOLD board of directors held a 1-day summit to learn more about the prevalence, causes, morality, clinical presentation, and resources for COPD management in low- and middle-income countries, where the burden of disease is particularly high. Discussion at the summit revealed that few pathophysiologic studies have been conducted to understand the differences in causes (eg, poor lung development vs adult exposure and smoking vs biomass smoke/pollution exposure). There is also a lack of epidemiologic data in many regions as well as little public awareness of COPD as a major health concern in low- and middle-income countries. More worrisome is the lack of both pharmacologic and nonpharmacologic interventions (eg, pulmonary rehabilitation) in these areas.

To make significant progress toward minimizing the burden of COPD across the globe, the board outlined the following actions:

Increase Awareness of COPD

  • Improve maternal nutrition and promote a healthy lifestyle
  • Minimize exposure to air pollution in childhood
  • Reduce adult smoking and encourage countries to adopt the WHO Framework Convention on Tobacco Control

Diagnose COPD Earlier

  • Use simple questionnaires to identify individuals with risk for COPD
  • Improve spirometry access and availability; use new technology to offer alternatives to conventional spirometry
  • Train community healthcare workers in early detection
  • Assess lung function at early age

Treat COPD Earlier and Effectively

  • Implement and promote smoking cessation programs
  • Decrease pollution exposure
  • Ensure drugs with proven efficacy and safety are available; use access programs to improve availability to patients
  • Promote awareness of evidence-based management guidelines
  • Train community healthcare workers in basic management

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“We call for a whole system approach that moves COPD management up a ladder of quality, driven by action and political pressure led by these organizations [Ministries of Health, national and international societies, and the pharmaceutical industry] and underpinned by the WHO,” the board wrote. “Contributors to the 2019 [United Nations] high-level meeting on universal health coverage must ensure that a minimum essential package of provisions for raising awareness of the disease, prevention, diagnosis and management is included in the political declaration and that they are backed up by sufficient financial resources and progress on implementation is monitored.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Halpin DMG, Celli BR, Criner GJ, et al. Is it time for the world to take COPD seriously: a statement from the GOLD board of directors [published online July 4, 2019]. Eur Respir J. doi:10.1183/13993003.00914-2019