GOLD Executive Summary (2004 Update):
Summary of Recommendations
Between April 1 and December 2003, 140 articles met the search criteria. Of these, 16 papers were identified to have an impact on the GOLD report, either by: 1) confirming, that is, adding or replacing an existing reference, or 2) modifying, that is, changing the text or introducing a concept that required a new recommendation to the report.

The most important changes can be summarized as follows:

• Page 14: A statement was added to indicate that withdrawal from treatment with inhaled glucocorticosteroids can lead to exacerbations in some patients.

• Page 14: Two new references have been added to further support the recommendation that inhaled glucocorticosteroids combined with a long acting 2-agonist is more effective that the individual components in symptomatic COPD patients with an FEV1 < 50% predicted (Stage III: Severe COPD and Stage IV: Very Severe COPD) and repeated exacerbations (Evidence A).

• Page 16: The recommendation for lung volume reduction surgery (LVRS) has been modified, reporting that it does not improve life expectancy b ut improves exercise capacity in patients with predominant upper lobe emphysema and a low post rehabilitation exercise capacity, and may improve global health status in patients with heterogeneous emphysema.

• Page 16: Based on a retrospective review of the literature triggered by new articles appearing after 2001, a new section has been added on recommendations for surgery in COPD.

Two additional issues were covered in the Workshop Report (updated 2004). On page 75, after a retrospective review of the literature triggered by a 2003 publication, a statement regarding the use of walking aids in patients with COPD has been added. On page 77, the role of oxygen supplementation before, during or after exercise has been discussed with the suggestion that there is no evidence of benefit from using short burst oxygen for symptom -matic relief before or after exercise.

The GOLD Science Committee acknowledged the publication of the ATS/ERS position paper on COPD1 that overall confirms almost all recommendations of the GOLD Workshop, but also expands some topics not covered or only marginally touched by the GOLD Reports. Prior to its release, the proposed modifications for the GOLD Workshop Report (Updated 2004) were submitted to the GOLD Executive Committee for approval.

The GOLD Workshop Report (Updated 2004), the GOLD Executive Summary(Updated 2004), and the GOLD Pocket Guide (Updated 2004) along with the complete list of references examined by the Committee are available on the GOLD website (www.goldcopd.org).