OBSTRUCTIVE, OCCUPATIONAL AND ENVIRONMENTAL DISEASES: Edited by Manish Joshi and Basil VarkeyAdherence to Global Initiative for Chronic Obstructive Lung Disease guidelines in the real world: current understanding, barriers, and solutionsAlbitar, Hasan Ahmad Hasana; Iyer, Vivek N.bAuthor Information aDepartment of Internal Medicine bDivision of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA Correspondence to Vivek N. Iyer, MD, MPH, Associate Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First ST SW, Rochester, MN 55905, USA. Tel: +1 507 284 2158; e-mail: [email protected] Current Opinion in Pulmonary Medicine: March 2020 - Volume 26 - Issue 2 - p 149-154 doi: 10.1097/MCP.0000000000000655 Buy Metrics Abstract Purpose of review The Global Initiative for Chronic Obstructive Lung Disease (GOLD) provides a comprehensive review and guidance for clinicians managing patients with chronic obstructive pulmonary disease (COPD). However, adherence to GOLD guidelines has been suboptimal over the years. The current review summarizes the current body of literature addressing the multitude of reasons for the lack of adherence to GOLD guidelines in clinical practice. Recent findings There continue to be several reasons for suboptimal adoption of GOLD guidelines in clinical practice. A primary and recurrent theme appears to be both delayed as well as missed diagnosis of COPD. There are several reasons for this including lack of awareness about current COPD guidelines, lack of availability as well as utilization of office spirometry and improper symptom assessment. Other issues include improper selection of proper pharmacotherapy options, misdiagnosis/mislabeling of COPD phenotypes, lack of smoking cessation counselling as well as enrollment in pulmonary rehabilitation. Potential solutions include adoption of clinical decision support systems, self-care models and careful phenotyping of COPD patients. Summary There are currently several barriers for the adoption of GOLD guidelines into routine clinical practice. These barriers are all amenable to systematic solutions that will increase adherence to current GOLD guidelines. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.