Gold 2023: Highlights for primary care

COPD is a common, preventable, and treatable disease, but extensive under-diagnosis and misdiagnosis leads to patients receiving no treatment or incorrect treatment1 . The realization that environmental factors other than tobacco smoking can contribute to COPD, that it can start early in life and affect young individuals, and that there are precursor conditions (“Pre-COPD”, “PRISm”), opens new windows of opportunity for its prevention, early diagnosis, and prompt and appropriate therapeutic intervention40,87. Importantly, several pharmacological (triple therapy) and non-pharmacological therapies (smoking cessation, long-term oxygen therapy, non-invasive positive pressure ventilation and lung volume reduction surgery) have now been shown to reduce mortality of COPD patients1 but, in order to implement them, COPD must be first diagnosed. Thus, any strategy aimed at addressing and improving the huge underdiagnosis of COPD in the community should be reinforced. This is particularly relevant in a Primary Care setting. Further, because spirometry may not only diagnose respiratory diseases, but it can also identify a group of young adults (20-25 years of age) at risk of other cardiovascular and metabolic comorbidities and premature mortality36, it has been proposed as a global marker of health88. Box 2 summarizes the main recommendations for the pharmacologic treatment of COPD in Primary Care.

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Autores: Alvar Agustí 1, Antoni Sisó-Almirall2, Miguel Roman3 and Claus F. Vogelmeier4 On behalf of the members of the Scientific Committee of GOLD (Appendix)