Table 8:
Practical goals | |
---|---|
Prohibit all kinds of smoking including—but not restricted to—cigarette smoking, water-pipe smoking, e-cigarette smoking (vaping), cannabis smoking, and smoking of other combustible substances | 50% of countries to ban smoking by 2035 |
Eliminate environmental exposures to anything but clean air, including indoor and outdoor pollution, wildfire smoke, and occupational exposures to toxic fumes and gasses; regulatory authorities should strengthen legislation governing acceptable levels of exposure to inhalable particulate matter and ozone | 50% of countries to introduce annual limits (lower than those recommended by WHO) for exposure to inhalable particulate matter <2·5 μm in diameter, particulate matter <10 μm in diameter, and ozone |
Support measures associated with improved and sustained general health, including reductions in global poverty and improvements in nutrition, vaccination, prenatal care, physical activity, and mental health | At least a 50% reduction in people living below the poverty-line by 2035; all countries should provide free vaccinations and mobilise educational campaigns to inform at-risk individuals; free or low-cost health care for all |
Diagnose COPD based on expanded criteria, including the presence of respiratory symptoms, personal history of risk factors, and persistent airflow limitation or ventilatory heterogeneity (as assessed by spirometry, other pulmonary function testing, or CT) | By 2035, the proportion of patients diagnosed with mild spirometric airflow obstruction should increase to at least 50% of the total |
Research and development should focus on treatment of early disease | By 2030, 75% of published clinical trials should be focused on patients with early or mild disease |
COPD should be classified into one of five types on the basis of the predominant risk factor present to increase awareness of risk factors, improve detection of people with non-smoking-related COPD and those with early disease, and foster research into therapies targeting specific disease mechanisms | COPD diagnosis by type should be included in the International Classification of Diseases coding system By 2035, at least one specific pharmacological or non-pharmacological therapy should be approved for each type of COPD |
Diagnosis of exacerbations should be based on a standard assessment confirmed by evidence of worsening airflow limitation or ventilatory heterogeneity, airways or systemic inflammation, or lung infection in a patient with increased respiratory symptoms (after exclusion of other disorders that mimic this presentation) | Exacerbation frequency should be similar worldwide by 2035 as a result of the establishment of a standard definition and assessment |
Effective pharmacological and non-pharmacological therapies should be made available worldwide; development of new therapies should focus on underlying pathophysiology and take into account disease heterogeneity (including COPD type) | By 2035, at least 80% of patients with COPD should have disease control, as evidenced by the absence of respiratory symptoms and exacerbations and normal or near-normal quality of life, exercise capacity, and life expectancy |
Definitions of treatment effectiveness should take patient-reported outcomes into account | By 2030, 75% of studies should include a patient-centred outcome as a primary outcome |
Regulatory agencies should regularly revisit and update endpoints for clinical trials of treatments for different COPD types | By 2035, 75% of new therapies should be approved on the basis of non-spirometric criteria |
Funding agencies should increase financial investments to adapt to the worldwide burden of COPD | By 2030, the total public and private global research and development expenditures for COPD should increase by 50% |
COPD=chronic obstructive pulmonary disease.