Carlos Cabrera López1, Ciro Casanova Macario2, José María Marín Trigo3, Juan P de-Torres4, Rebeca Sicilia Torres1, Jesús María González5, Francesca Polverino6, Miguel Divo6, Víctor Pinto Plata7, Javier J Zulueta4, Bartolomé Celli6. 1. 1 Respiratory Service, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain. 2. 2 Respiratory Service, Hospital Universitario Nuestra Señora de la Candelaria, Canary Islands, Spain. 3. 3 Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain. 4. 4 Respiratory Service, Clínica Universitaria de Navarra, Pamplona, Spain. 5. 5 Investigation Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Canary Islands, Spain. 6. 6 Pulmonary and Critical Care Service, Brigham and Women's Hospital, Boston, Massachusetts and. 7. 7 Pulmonary and Critical Care Division, Baystate Medical Center, Springfield, Massachusetts.
Abstract
RATIONALE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document has modified the grading system directing pharmacotherapy, but how this relates to the previous one from 2015 and to comorbidities, hospitalizations, and mortality risk is unknown. OBJECTIVES: The aim of this study was to evaluate the changes in the GOLD groups from 2015 to 2017 and to assess the impact on severity, comorbidities, and mortality within each group. METHODS: We prospectively enrolled and followed, for a mean of 5 years, 819 patients with chronic obstructive pulmonary disease (84% male) in clinics in Spain and the United States. We determined anthropometrics, lung function (FEV1%), dyspnea score (modified Medical Research Council scale), ambulatory and hospital exacerbations, and the body mass index, obstruction, dyspnea, and exercise capacity (BODE) and Charlson indexes. We classified patients by the 2015 and 2017 GOLD ABCD system, and compared the differential realignment of the same patients. We related the effect of the reclassification in BODE and Charlson distribution as well as chronic obstructive pulmonary disease and all-cause mortality between the two classifications. MEASUREMENTS AND MAIN RESULTS: Compared with 2015, the 2017 grading decreased by half the proportion of patients in groups C and D (20.5% vs. 11.2% and 24.6% vs. 12.9%; P < 0.001). The distribution of Charlson also changed, whereas group D was higher than B in 2015, they become similar in the 2017 system. In 2017, the BODE index and risk of death were higher in B and D than in A and C. The mortality risk was better predicted by the 2015 than the 2017 system. CONCLUSIONS: Compared with 2015, the GOLD ABCD 2017 classification significantly shifts patients from grades C and D to categories A and B. The new grading system equalizes the Charlson comorbidity score in all groups and minimizes the differences in BODE between groups B and D, making the risk of death similar between them.
RATIONALE: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document has modified the grading system directing pharmacotherapy, but how this relates to the previous one from 2015 and to comorbidities, hospitalizations, and mortality risk is unknown. OBJECTIVES: The aim of this study was to evaluate the changes in the GOLD groups from 2015 to 2017 and to assess the impact on severity, comorbidities, and mortality within each group. METHODS: We prospectively enrolled and followed, for a mean of 5 years, 819 patients with chronic obstructive pulmonary disease (84% male) in clinics in Spain and the United States. We determined anthropometrics, lung function (FEV1%), dyspnea score (modified Medical Research Council scale), ambulatory and hospital exacerbations, and the body mass index, obstruction, dyspnea, and exercise capacity (BODE) and Charlson indexes. We classified patients by the 2015 and 2017 GOLD ABCD system, and compared the differential realignment of the same patients. We related the effect of the reclassification in BODE and Charlson distribution as well as chronic obstructive pulmonary disease and all-cause mortality between the two classifications. MEASUREMENTS AND MAIN RESULTS: Compared with 2015, the 2017 grading decreased by half the proportion of patients in groups C and D (20.5% vs. 11.2% and 24.6% vs. 12.9%; P < 0.001). The distribution of Charlson also changed, whereas group D was higher than B in 2015, they become similar in the 2017 system. In 2017, the BODE index and risk of death were higher in B and D than in A and C. The mortality risk was better predicted by the 2015 than the 2017 system. CONCLUSIONS: Compared with 2015, the GOLD ABCD 2017 classification significantly shifts patients from grades C and D to categories A and B. The new grading system equalizes the Charlson comorbidity score in all groups and minimizes the differences in BODE between groups B and D, making the risk of death similar between them.
Entities:
Keywords:
Global Initiative for Chronic Obstructive Lung Disease; chronic obstructive pulmonary disease; prevalence
Authors: Wassim W Labaki; Meng Xia; Susan Murray; Jeffrey L Curtis; R Graham Barr; Surya P Bhatt; Eugene R Bleecker; Nadia N Hansel; Christopher B Cooper; Mark T Dransfield; J Michael Wells; Eric A Hoffman; Richard E Kanner; Robert Paine; Victor E Ortega; Stephen P Peters; Jerry A Krishnan; Russell P Bowler; David J Couper; Prescott G Woodruff; Fernando J Martinez; Carlos H Martinez; MeiLan K Han Journal: Respir Med Date: 2018-06-05 Impact factor: 3.415
Authors: Wassim W Labaki; Lucas M Kimmig; Gökhan M Mutlu; MeiLan K Han; Surya P Bhatt Journal: Am J Respir Crit Care Med Date: 2019-06-15 Impact factor: 21.405
Authors: Seppo T Rinne; Renda Soylemez Wiener; Yahong Chen; Peter Rise; Edmunds Udris; Laura C Feemster; David H Au Journal: Am J Respir Crit Care Med Date: 2018-11-01 Impact factor: 21.405
Authors: Marek Plutinsky; Kristian Brat; Michal Svoboda; Jaromir Zatloukal; Patrice Popelkova; Vladimir Koblizek Journal: Lung Date: 2019-01-29 Impact factor: 2.584
Authors: Matthew Strand; Erin Austin; Matthew Moll; Katherine A Pratte; Elizabeth A Regan; Lystra P Hayden; Surya P Bhatt; Aladin M Boriek; Richard Casaburi; Edwin K Silverman; Spyridon Fortis; Ingo Ruczinski; Harald Koegler; Harry B Rossiter; Mariaelena Occhipinti; Nicola A Hanania; Hirut T Gebrekristos; David A Lynch; Ken M Kunisaki; Kendra A Young; Jessica C Sieren; Margaret Ragland; John E Hokanson; Sharon M Lutz; Barry J Make; Gregory L Kinney; Michael H Cho; Massimo Pistolesi; Dawn L DeMeo; Frank C Sciurba; Alejandro P Comellas; Alejandro A Diaz; Igor Barjaktarevic; Russell P Bowler; Richard E Kanner; Stephen P Peters; Victor E Ortega; Mark T Dransfield; James D Crapo Journal: Chronic Obstr Pulm Dis Date: 2020-10