María Victorina López Varela

Universidad de la República

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María Montes de

Central University of Venezuela

Bartolomé R. Celli

Brigham and Women's Hospital

Gerard J. Criner

Temple University

Claus Vogelmeier

German Center for Lung Research

Alejandro Casas

Fundación Neumológica Colombiana

ÀA

Àlvar Agustí

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

David Halpin

University of Exeter

Dave Singh

University of Manchester

Peter J. Barnes

Imperial College London

Nicolás Roche

Université Paris Cité

Cooperative Institutions

Hospital Maciel

Universidade Federal de São Paulo

Instituto Nacional de Enfermedades Respiratorias

Universidad de la República

Instituto do Sono

Universidade Federal de Pelotas

Central University of Venezuela

Hospital Clínico Universitario de Caracas

Fundación Neumológica Colombiana

Universidad Nacional Autónoma de México

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The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries

The International Journal of Tuberculosis and Lung Disease (2019)

David Halpin Bartolomé R. Celli Gerard J. Criner Peter Frith María Victorina López Varela

Chronic obstructive pulmonary disease (COPD) is one of the top three causes of death worldwide, but governments and non-governmental organisations have not given its prevention and treatment the priority it requires. This is particularly true in low- and middle-income countries, where most of the people suffering from this disease live. The United Nations (UN) has targeted a reduction of premature deaths from non-communicable diseases (NCDs) by a third by 2030; however, a coordinated UN/World Health Organization (WHO) strategy to address the burden of COPD (one of the most important NCDs) is still lacking. To explore the extent of the problem and inform the development of policies to improve the situation, the Board of Directors of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) held a 1-day Summit. The key themes that emerged were the need to ensure accurate data on prevalence, raise awareness of the disease among the public, healthcare professionals and governments, including the fact that COPD aetiology goes beyond smoking (and other inhaled pollutants) and includes poor lung development in early life, and ensure that spirometry and both pharmacological and non-pharmacological therapies are available and affordable. Here, we present the actions that must be taken to address the impact of COPD. We believe that the WHO is particularly well-positioned to co-ordinate an attack on COPD, and GOLD will do all it can to help and rally support.

Summit

Non-communicable disease

Obstructive lung disease

Middle income

10.5588/ijtld.19.0397

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Citations (178)

Diagnostic accuracy of the combined modality of a questionnaire and a portable device for COPD case finding: Experience with the PUMA questionnaire

Archivos de Bronconeumología (2024)

María Montes de María Victorina López Varela

Modality (human–computer interaction)

Puma

Case finding

10.1016/j.arbres.2024.07.025

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Citations (0)

Perceptions of short and long sleep duration and comorbid conditions: the PLATINO study

Sleep Medicine (2013)

Luis Torre‐Bouscoulet Cecilia García Sancho Juan Carlos Vázquez-García Cesar Manuel Salazar-Peña María Victorina López Varela

Vital capacity

Sleep

Phlegm

10.1016/j.sleep.2013.04.014

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Citations (14)

Guía de práctica clínica de la enfermedad pulmonar obstructiva crónica (EPOC) ALAT-2014: Preguntas y respuestas

Archivos de Bronconeumología (2015)

María Montes de María Victorina López Varela Agustín Acuña Eduardo Schiavi María Alejandra Rey

Lama

Clinical Practice

10.1016/j.arbres.2014.11.017

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Citations (44)

Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease: the GOLD science committee report 2019

European Respiratory Journal (2019)

Dave Singh Àlvar Agustí Antonio Anzueto Peter J. Barnes Jean Bourbeau

Precision medicine is a patient-specific approach that integrates all relevant clinical, genetic and biological information in order to optimise the therapeutic benefit relative to the possibility of side-effects for each individual. Recent clinical trials have shown that higher blood eosinophil counts are associated with a greater efficacy of inhaled corticosteroids (ICSs) in chronic obstructive pulmonary disease (COPD) patients. Blood eosinophil counts are a biomarker with potential to be used in clinical practice, to help target ICS treatment with more precision in COPD patients with a history of exacerbations despite appropriate bronchodilator treatment.The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 pharmacological treatment algorithms, based on the ABCD assessment, can be applied relatively easily to treatment-naive individuals at initial presentation. However, their use is more problematic during follow-up in patients who are already on maintenance treatment. There is a need for a different system to guide COPD pharmacological management during follow-up.Recent large randomised controlled trials have provided important new information concerning the therapeutic effects of ICSs and long-acting bronchodilators on exacerbations. The new evidence regarding blood eosinophils and inhaled treatments, and the need to distinguish between initial and follow-up pharmacological management, led to changes in the GOLD pharmacological treatment recommendations. This article explains the evidence and rationale for the GOLD 2019 pharmacological treatment recommendations.

Obstructive lung disease

Gold standard (test)

10.1183/13993003.00164-2019

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Citations (1,654)

Bronchodilator treatment for COPD in primary care of four Latin America countries: The multinational, cross-sectional, non-interventional PUMA study

Pulmonary Pharmacology & Therapeutics (2016)

María Montes de María Victorina López Varela José R. Jardim Roberto Stirvulov Filip Surmont

Cross-sectional study

Chronic bronchitis

10.1016/j.pupt.2016.04.002

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Citations (22)

COPD classification according GOLD 2013 and Latin American Thoracic Association (ALAT) recommendations in PUMA study

Epidemiology (2016)

María Montes de María Victorina López Varela Maria Eugenia Laucho Contreras Alejandro Casas Eduardo Schiavi

Background: It is recognized that FEV₁ alone fails to represent the complexity of COPD. GOLD-2013 recommends a multidimensional assessment based on symptoms (mMRC or CAT) and future risk (airflow limitation/exacerbations-hospitalizations). ALAT guidelines also recommend to assess COPD severity based dyspnea severity (mMRC: 0-1 mild, 2 moderate, 3 severe, 4 very-severe), airflow limitation (FEV₁%: >80%-mild, 50-80%-moderate, 50-30%-severe, <30%-very-severe) and exacerbations-hospitalizations in the previous-year (severe to very-severe: ≥2 exacerbations or ≥1 hospitalized exacerbation). Objectives: To compare the COPD prevalence according to GOLD-2013 and ALAT-2014, and the distribution of COPD severity according these two stratifications in a primary-care COPD population from Latin America. Methods: COPD was defined as post-bronchodilator FEV₁/FVC<0.70 and categories according to GOLD-2013 (A,B,C,D) and by ALAT-2014 (mild, moderate, severe, very-severe). Results: 1,540 completed interview and spirometry, 309 had COPD (FEV₁/FVC<0.70 post-BD). According GOLD-2013 COPD prevalence was: 9.3-A, 4.3-B, 2.0-C and 4.6-D. By ALAT was: 2.9-Mild, 9-Moderate, 5.4-Severe, and 2.7-Very severe. The severity proportion according to both classifications is shown. Conclusions: Patients seem to shift to more severe stages with ALAT classification compared to GOLD-2013.

Gold standard (test)

10.1183/13993003.congress-2016.pa4236

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Bronchodilator use in Latin America primary care: The PUMA study

05.01 - Airway pharmacology and treatment (2016)

María Montes de María Victorina López Varela José Roberto Jardim Roberto Stirvulov Filip Surmont

Background: Bronchodilators (BDs) underuse have been frequently reported by COPD real-life studies. PUMA is an opportunistic COPD case finding study in primary care in Argentina, Colombia, Venezuela and Uruguay that could help to understand the use of BDs. Objectives: To determine the frequency of long-acting (LA) and short-acting (SA) BDs use with or without corticosteroid (CS) and their use as-needed (rescue) or on regular-basis (maintenance) in patients from primary care at risk for COPD. Methods: COPD was defined as post-BD FEV₁/FVC<0.70. Prior medical diagnostic of COPD was determined using self-reported physician diagnosis of emphysema, chronic bronchitis, or COPD. Results: 1,743 patients were interviewed, 1,540 completed spirometry, 309 had spirometric criteria of COPD, and 102 had COPD prior medical diagnosis. 24.9% of the patients (FEV1/FVC<0.70 post-BD) used BDs (3.6% of them LA-BD), and 15.2% BD+CS (13.6% of them LA-BD+CS). In those with COPD prior medical diagnosis 64.7% used BDs (9.8% of them LA-BD), and 25.6% BD+CS (13.6% of them LA-BD+CS). The use of BDs as rescue or maintenance is shown. Conclusions: 35% of patients with COPD prior medical diagnosis in Latin American primary care don´t use BDs, LA-BDs are underused and only 27.9% of patients receiving them as maintenance. This represents a considerable gap between guideline recommendations and the BD prescribing pattern in Latin America.

Guideline

Chronic bronchitis

10.1183/13993003.congress-2016.pa4076

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COPD heterogeneity: An epidemiological perspective from the PLATINO study

European Respiratory Journal (2011)

María Victorina López Varela María Montes de Adriana Muiño Carlos Tálamo Dolores Moreno

PLATINO offers an opportunity to characterise COPD heterogeneity in a population-based multicenter study. 759 COPD and 4,554 non-COPD individuals were included. COPD was characterised for potential phenotypes. Dyspnea, health status (HS) and physical limitations similar in non-obstructed and stage-1. mMRC (2+) and physical limitations were reported by 61.2% and 27.1% of stage-2, vs 80.8% and 55.8% of stage-3&4 patients, respectively. Good-excellent HS was reported in 58.6% of stage-2 vs 32.6% of stages-3&4 individuals. BMI: higher proportion of COPD were in underweight-normal vs. obese category (27.4 vs 10.9%). A subgroup of severe COPD reported dyspnea mMRC 1, no physical limitation, or were obese. Acute bronchodilator responsiveness (ABR): was present in 51.2% of stage-1 vs 6.8% of stages-3&4 (p Exacerbations: increased from 4.2% in stage-1 to 28.9% in stages- 3&4 (present on a subgroup of subjects). Gender: females vs men reported more fair-poor HS (40 vs 28%, p Co-morbidities: females had a higher co-morbidity score (1.35±0.1 vs 1.01±0.1, p Chronic bronchitis: was present in 8.56% of COPD, preponderance in males 65.5% (p=0.01) and current smokers 47.6% (p=0.005). In conclusion, PLATINO data show a significant COPD heterogeneity even at same severity stages. A better understanding of potential phenotypes should probably come through the follow up “PLATINO Cohort Study”.

Chronic bronchitis

Underweight

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Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary

European Respiratory Journal (2023)

Àlvar Agustí Bartolomé R. Celli Gerard J. Criner David Halpin Antonio Anzueto

Executive summary of the Global Strategy for Prevention, Diagnosis and Management of COPD 2023: the latest evidence-based strategy document from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) https://bit.ly/3KCaTGe

Obstructive lung disease

Executive summary

Gold standard (test)

10.1183/13993003.00239-2023

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Citations (586)