Table 1.

Short summary of several recent COPD guidelines

	Country, institution
Guidelines parameter	Spain, GesEPOC	Czech Republic, CPPS	Finland, FMSD/FRS	India, Indian Chest Society/NCCP	Saudi Arabia, STS	Global, GOLD
Guided by	Phenotypes alone	GOLDa and phenotypes	GOLDb and phenotypes	GOLD and phenotypesc	Three phenotypic classesd	GOLD alone
Mainly focused on	GPs + PFs	PFs	GPs	GPs	GPs + INs + PFs	GPs + PFs
Valid since	2012	2013	2014	2013	2014	2015
Spirometry post-BD	Mandatory	Mandatory	Mandatory	Mandatory	Mandatory	Mandatory
Airflow limitation definition	FEV1/FVC <0.7	FEV1/VC <LLN	FEV1/FVC <0.7	FEV1/FVC <LLNe	FEV1/FVC <0.7	FEV1/FVC <0.7
Frequent exacerbator means	≥2/year	≥2/year	≥2/year or ≥1/year leading to hospital admission	≥2/year	≥2/year or ≥1/year leading to hospital admission	≥2/year or ≥1/year leading to hospital admission
High level of symptoms	CAT ≥10 (mMRC scale ≥2)	CAT ≥10 (mMRC scale ≥1)	CAT ≥10	mMRC scale ≥2 (CAT ≥10)	CAT ≥10	CAT ≥10 or mMRC scale ≥2
Smoking cessation	Mandatory	Mandatory	Mandatory	Mandatoryf	Mandatoryg	Mandatory
BD’s role	Mandatory	Mandatory	Mandatory	Mandatory, short-acting only, long-acting for moderate and severe categories	Mandatory	Mandatory
ICS role	FAEs or ACOS	FAEs or ACOS	FAEs or ACOS	Severe category	FAEs (Class III)	C and D categories
Mucoactive drugs’ role	FAEs	FAEs with chronic bronchitis, or BCOS	FAEs	NR	Optional	D category
Long-term ATB role	FAEs with chronic bronchitis	FAEs with chronic bronchitis or with BCOS	NR	NR	NR	NR
Methylxanthines role	Optional	Optional	Optional	Optional	Optional	Optional
Roflumilast role	FAEs with chronic bronchitis and FEV1 <50%	FAEs with chronic bronchitis and FEV1 <50%	FAEs with chronic bronchitis and FEV1 <50%	Severe category	FAEs with chronic bronchitis (Class III)	D GOLD category with chronic bronchitis and FEV1 < 50%
Training of inhalation	Mandatory	Mandatory	Mandatory	Mandatory	Mandatory	Mandatory
Regular physical activity	Mandatory	Mandatory	Mandatory	Mandatory	Mandatory	Mandatory
Influenza and pneumococcal vaccination	Mandatory	Mandatory	Mandatory	Optional	Mandatory	Mandatory

Notes:

^aCzech guidelines use slightly modified GOLD categories.

^bFinnish guidelines use GOLD 1–4 grading (according to post-BD FEV₁).

^cClassification of severity of the disease (into three categories) should be done for all COPD patients based on the post-BD FEV₁, exacerbation frequency, mMRC dyspnea scale, and presence of respiratory failure/cor pulmonale/secondary polycythemia.

^dThose patients with low risk of exacerbation (less than two in the past year) can be classified as either Class I when they have less symptoms or Class II when they have more symptoms (CAT ≥10). High-risk COPD patients, as manifested with more than or equal to two exacerbations or hospitalization in the past year irrespective of the baseline symptoms, are classified as Class III.

^eIn the absence of reference equations for LLN, FEV₁/FVC <0.7 may be used as the cutoff for defining airflow obstruction.

^FIncluded Bidi and other indigenous forms of tobacco smoking; exposure to biomass fuel smoke is a strong risk factor for COPD in India.

^gIncluded shisha (water pipe). Data from GOLD,¹ Miravitlles et al,¹⁷ Kankaanranta et al,⁵¹ Gupta et al,⁵² Khan et al,⁵³ and Koblizek et al.⁵⁴

Abbreviations: ACOS, asthma and COPD overlap; ATBs, antibiotics; BCOS, bronchiectasis and COPD overlap syndrome; BD, bronchodilator; CAT, COPD Assessment Test; CPPS, Czech Pneumological and Phthisiological Society; FAEs, frequent acute exacerbators; FEV₁, forced expiratory volume in 1 second; FMSD, Finnish Medical Society Duodecim; FRS, Finnish Respiratory Society; FVC, forced volume vital capacity; GesEPOC, La Guía Española de la EPOC (Spanish COPD Guidelines); GOLD, Global Initiative for Chronic Obstructive Lung Disease; GPs, general practitioners; ICS, inhaled corticosteroids; INs, internists; LLN, the lower limit of normal; mMRC, modified Medical Research Council; NCCP, National College of Chest Physicians (India); NR, not recommended; PFs, pulmonary physicians; STS, Saudi Thoracic Society; VC, vital capacity.