What was the Impact of the Spanish COPD Guidelines (GesEPOC) and how can They be Improved?

Abstract

Before reading any further, the reader should be advised that the author of this editorial has a clear intellectual conflict with its contents, as he has collaborated intensively in drawing up the Spanish COPD Guidelines (GesEPOC).1 Therefore, it is highly likely that the opinions expressed below are biased by a view conditioned by the guideline drafting process. Nevertheless, this view does not prevent the author from seeing, hearing and valuing the sincere, although not always favourable, opinions of many colleagues. If this introduction has not discouraged the reader, I hope that the time spent reading this editorial will be worthwhile. GesEPOC does not stand in opposition to anyone or anything, but follows the trend set by a very relevant article published in 2010.2 It is true that GesEPOC sought to innovate, based on the widely accepted concept that we had to go beyond the forced expiratory volume in the first second (FEV1), and that types (or phenotypes) of patients who share characteristics and responses to treatments had to be identified.3 Innovation is always a risk, but we thought that sufficient evidence had been gathered to justify launching a proposal of this type. Almost simultaneously, the Global Obstructive Lung Disease (GOLD) initiative also launched its proposal to go beyond the FEV1, albeit differently. 4 The concurrence of these different ways of addressing the same reality has generated considerable debate and, sincerely, I believe that COPD in general has benefitted, even at the risk of adding to the confusion. There is no doubt that the GOLD document is a global reference, but it is not unanimously accepted5; GesEPOC is, or should be, the reference guide in Spain, but it is also true that it is not unanimously accepted nationally. What has publication of the Spanish COPD guidelines meant? We can list a number of answers: (a) recognition and dissemination of the complexity of COPD. There is not one COPD, but several, and it is the clinician’s responsibility to recognize these different profiles or phenotypes; (b) it has encouraged multidimensional evaluation of COPD severity with the BODE/BODEx indices; (c) dissemination of the mixed COPD-asthma phenotype (better known as asthma-