Rosa Faner1, Guillaume Noell1, Joan Ramon Badia2, Alejandra López-Giraldo2, Per Bakke3, Edwin K Silverman4, Ruth Tal-Singer5, Alvar Agustí6. 1. CIBER Enfermedades Respiratorias, Spain; Institut de Recerca Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain. 2. CIBER Enfermedades Respiratorias, Spain; Institut de Recerca Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Respiratory Institute, Hospital Clinic, University of Barcelona, Spain. 3. Department of Clinical Science, University of Bergen, Bergen, Norway. 4. Channing Division of Network Medicine. Brigham and Women's Hospital. Boston, MA, USA. 5. GlaxoSmithKline Research and Development, Collegeville, PA, USA. 6. CIBER Enfermedades Respiratorias, Spain; Institut de Recerca Biomedica August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Respiratory Institute, Hospital Clinic, University of Barcelona, Spain. Electronic address: aagusti@clinic.cat.
Abstract
BACKGROUND: In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed a new classification of patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We contrasted the distribution of COPD patients according to GOLD 2017 and 2011 classifications, the temporal stability of the 2017 groups during 3 years follow-up and their association with all-cause mortality in the ECLIPSE cohort. RESULTS: We found that GOLD 2017: (1) switched a substantial proportion of GOLD 2011C and D patients to A and B groups at recruitment; (2) about half of A, B and D patients remained in the same group at the end of follow-up, whereas 74% of C patients (the smallest group of all) changed, either because exacerbation rate decreased or dyspnea increased; and, (3) all-cause mortality by group was not significantly different between GOLD 2011 and 2017. Of note, mortality in B (16%) and D patients (18%) was similar, both with similar severity of airflow limitation, the best individual mortality risk factor. CONCLUSIONS: These results illustrate the cross-sectional and longitudinal effects of excluding FEV1 from GOLD 2017, and highlight both the clinical relevance of symptom assessment in the management of COPD and the prognostic capacity of FEV1.
BACKGROUND: In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed a new classification of patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: We contrasted the distribution of COPDpatients according to GOLD 2017 and 2011 classifications, the temporal stability of the 2017 groups during 3 years follow-up and their association with all-cause mortality in the ECLIPSE cohort. RESULTS: We found that GOLD 2017: (1) switched a substantial proportion of GOLD 2011C and D patients to A and B groups at recruitment; (2) about half of A, B and D patients remained in the same group at the end of follow-up, whereas 74% of C patients (the smallest group of all) changed, either because exacerbation rate decreased or dyspnea increased; and, (3) all-cause mortality by group was not significantly different between GOLD 2011 and 2017. Of note, mortality in B (16%) and D patients (18%) was similar, both with similar severity of airflow limitation, the best individual mortality risk factor. CONCLUSIONS: These results illustrate the cross-sectional and longitudinal effects of excluding FEV1 from GOLD 2017, and highlight both the clinical relevance of symptom assessment in the management of COPD and the prognostic capacity of FEV1.
Authors: Lan Ai Kieu Le; Ane Johannessen; Jon Andrew Hardie; Odd Erik Johansen; Amund Gulsvik; Bjørn Egil Vikse; Per Bakke Journal: Int J Chron Obstruct Pulmon Dis Date: 2019-07-23