Kathrin Kahnert1, Peter Alter2, David Young3, Tanja Lucke4, Joachim Heinrich4, Rudolf M Huber5, Jürgen Behr5, Margarethe Wacker6, Frank Biertz7, Henrik Watz8, Robert Bals9, Tobias Welte10, Hubert Wirtz11, Felix Herth12, Jørgen Vestbo13, Emiel F Wouters14, Claus F Vogelmeier2, Rudolf A Jörres4. 1. Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336 Munich, Germany. Electronic address: kathrin.kahnert@med.uni-muenchen.de. 2. Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Germany, Member of the German Center for Lung Research (DZL), Baldingerstrasse, 35043 Marburg, Germany. 3. Young Medical Communications and Consulting Ltd, Horsham RH12 3NU, UK. 4. Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center Munich (CPC-M), Ludwig-Maximilians-Universität München, Ziemssenstr. 1, 80336 Munich, Germany. 5. Department of Internal Medicine V, University of Munich (LMU), Comprehensive Pneumology Center, Member of the German Center for Lung Research, Ziemssenstr. 1, 80336 Munich, Germany. 6. Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH) - German Research Center for Environmental Health, Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Ingolstaedter Landstr. 1, 85764 Neuherberg, Germany. 7. Institute for Biostatistics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. 8. Pulmonary Research Institute at LungenClinic Grosshansdorf, Airway Research Center North, Member of the German Center for Lung Research, Woehrendamm 80, 22927 Grosshansdorf, Germany. 9. Department of Internal Medicine V - Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Kirrberger Straße 1, 66424 Homburg, Germany. 10. Department of Pneumology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. 11. Department of Internal Medicine I, Pneumology, University of Leipzig, Liebigstr. 20, Haus 4, 04103 Leipzig, Germany. 12. Thoraxklinik-Heidelberg gGmbH, Röntgenstraße 1, 69126 Heidelberg, Germany. 13. Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, The University of Manchester and South Manchester University Hospital NHS Foundation Trust, Manchester, UK. 14. Department of Respiratory Medicine, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
Abstract
INTRODUCTION: The COPD classification proposed by the Global Initiative for Obstructive Lung Disease was recently revised, and the A to D grouping is now based on symptoms and exacerbations only. Potential associations with comorbidities have not been assessed so far. Thus the aim of the present study was to determine the relationship between the revised (2017) GOLD groups A-D and major comorbidities. METHODS: We used baseline data from the COPD cohort COSYCONET. Comorbidities were identified from patient self-reports and disease-specific medication: gastrointestinal disorders, asthma, sleep apnea, hyperuricemia, hyperlipidemia, diabetes, osteoporosis, mental disorders, heart failure, hypertension, coronary artery disease. The A-D groups were based on either the COPD Assessment Test or the modified Medical Research Council scale. Exacerbations were also categorized as per GOLD recommendations. RESULTS: Data from 2228 patients were analyzed. Using GOLD group A as a reference, group D was associated with nearly all comorbidities, followed by group B and C. When groups A-D were dichotomized as AC vs. BD (symptoms) and AB vs. CD (exacerbations), all comorbidities correlated with symptoms and/or exacerbations. This was true for both mMRC- and CAT-based categorizations. CONCLUSIONS: These findings suggest that the recently modified GOLD categorization is clinically relevant beyond being purely an assessment of symptoms and exacerbations. As the A-D groups correlated with the risk of important comorbidities, with some differences in terms of the correlation with symptoms and exacerbations, the findings underline the importance of identifying comorbidities in COPD, particularly in non-responders to therapy who have high symptoms and/or exacerbation rates.
INTRODUCTION: The COPD classification proposed by the Global Initiative for Obstructive Lung Disease was recently revised, and the A to D grouping is now based on symptoms and exacerbations only. Potential associations with comorbidities have not been assessed so far. Thus the aim of the present study was to determine the relationship between the revised (2017) GOLD groups A-D and major comorbidities. METHODS: We used baseline data from the COPD cohort COSYCONET. Comorbidities were identified from patient self-reports and disease-specific medication: gastrointestinal disorders, asthma, sleep apnea, hyperuricemia, hyperlipidemia, diabetes, osteoporosis, mental disorders, heart failure, hypertension, coronary artery disease. The A-D groups were based on either the COPD Assessment Test or the modified Medical Research Council scale. Exacerbations were also categorized as per GOLD recommendations. RESULTS: Data from 2228 patients were analyzed. Using GOLD group A as a reference, group D was associated with nearly all comorbidities, followed by group B and C. When groups A-D were dichotomized as AC vs. BD (symptoms) and AB vs. CD (exacerbations), all comorbidities correlated with symptoms and/or exacerbations. This was true for both mMRC- and CAT-based categorizations. CONCLUSIONS: These findings suggest that the recently modified GOLD categorization is clinically relevant beyond being purely an assessment of symptoms and exacerbations. As the A-D groups correlated with the risk of important comorbidities, with some differences in terms of the correlation with symptoms and exacerbations, the findings underline the importance of identifying comorbidities in COPD, particularly in non-responders to therapy who have high symptoms and/or exacerbation rates.
Authors: Peter Alter; Jan Orszag; Christina Kellerer; Kathrin Kahnert; Tim Speicher; Henrik Watz; Robert Bals; Tobias Welte; Claus F Vogelmeier; Rudolf A Jörres Journal: ERJ Open Res Date: 2020-07-27
Authors: Jana Graf; Rudolf A Jörres; Tanja Lucke; Dennis Nowak; Claus F Vogelmeier; Joachim H Ficker Journal: Dtsch Arztebl Int Date: 2018-09-14 Impact factor: 5.594
Authors: F C Trudzinski; R A Jörres; P Alter; K Kahnert; B Waschki; C Herr; C Kellerer; A Omlor; C F Vogelmeier; S Fähndrich; H Watz; T Welte; B Jany; S Söhler; F Biertz; F Herth; H-U Kauczor; R Bals Journal: Sci Rep Date: 2020-06-29 Impact factor: 4.379
Authors: Alicia Gayle; Scott Dickinson; Kevin Morris; Chris Poole; Alexander G Mathioudakis; Jørgen Vestbo Journal: Int J Chron Obstruct Pulmon Dis Date: 2018-10-23
Authors: Russell G Buhr; Nicholas J Jackson; Gerald F Kominski; Steven M Dubinett; Michael K Ong; Carol M Mangione Journal: BMC Health Serv Res Date: 2019-10-15 Impact factor: 2.655
Authors: Christos Baliatsas; Lidwien A M Smit; Michel L A Dückers; Christel E van Dijk; Dick Heederik; C Joris Yzermans Journal: BMC Pulm Med Date: 2019-06-10 Impact factor: 3.317