Characteristics of a COPD population categorised using the GOLD framework by health status and exacerbations

Abstract

GOLD proposed a COPD assessment framework focussed on symptoms measured by the COPD Assessment Test™ (CAT) or the mMRC and on exacerbation risk based on poor lung function (FEV1 <50%) or a history of ≥2 exacerbations in the previous year. This analysis examined the characteristics of COPD patients recruited from routine clinical settings and classified using the GOLD framework. 1041 European COPD patients (38.5% from primary care) from the Adelphi Respiratory Disease Specific Programme with information on CAT, mMRC, spirometry and exacerbation history in the previous year were analysed. Their mean age was 64.9 ± 9.9 years and mean FEV1 was 62.5 ± 17.8% predicted; 80% were in GOLD 2 spirometric grade or milder. CAT and mMRC cut points identified different groups of patients; using CAT, the composition was: Group A 9.3%, Group B 48.5%, Group C 0.7% and Group D 41.5%. 80% were classified as high risk based on exacerbation history and 25% of patients in a low risk category (GOLD A and B) had 1 exacerbation in the previous year. The incidence of diabetes, hypertension and hyperlipidaemia rose with worsening GOLD group (all p < 0.0001); diabetes GOLD A 4%, GOLD B 16%, GOLD D 29%; hypertension GOLD A 38%, GOLD B 55%, GOLD D 65%; hyperlipidaemia GOLD A 13%, GOLD B 30%, GOLD D 37%. In patients seen in routine clinical settings, 25% of GOLD low risk patients had one exacerbation per year and the incidence of cardio-vascular and metabolic diseases increases with worsening GOLD group.

Impact of Chronic Obstructive Pulmonary Disease (COPD) on Patient’s Life and His Family

“…In the new classification, the shift of patients towards category D with a high risk in comparison to not numerous grade IV from the previous classification is caused by recurrent exacerbations (≥ 2/year) in a significant proportion of respondents (in this way 80% patients were classified to groups D or C). But in the two quoted studies there is a higher proportion of patients from groups B or D in relation to the present study, which results from more severe symptoms (in the present study A+C/B+D -69%/31% vs. Johannessen [13] 26%/74% vs. Jones [14] 10%/90% for CAT and 51%/49% for mMRC). It is possible that the differences also result from the intensity of treatment; the quoted studies do not contain data about the used therapy.…”

“…The limitation of the cohort was the fact that it recruited patients with FEV 1 below 80% of predicted value, so it excluded patients with a mild degree of obturation, which made the proportion of patients in groups A and B smaller, and consequently made the proportion of patients in groups C and D bigger. Jones et al [14] also classified patients according to the 2011 GOLD. The cohort from the Adelphi Respiratory Disease Specific Programme, similarly as in the previous study, consisted of approximately 1000 patients recruited during routine visits (38.5% primary care clinic).…”

GOLD 2017 recommendations for COPD patients: toward a more personalized approach

“…Moreover, the GOLD 2011 re-classification shifted the overall COPD severity distribution to more severe categories, but without clearly documented benefits on outcomes [14]. Furthermore, the ABCD classification based on airflow severity and patient-reported outcome caused some confusion: for example, group C (high risk without significant symptoms) was rather uncommon, and had similar exacerbation frequency than group B (high symptoms but low risk); on the other hand, group D (which included subjects with severe airflow limitation alone, or with history of frequent exacerbations alone, or with both risk factors) had significant heterogeneity in exacerbation rate [15,16].…”

Management of Chronic Obstructive Pulmonary Disease: A Personalized Interpretation of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) - ABCD Recommendations

“…Data from different COPD cohorts have been used to understand the percentage of patients falling into groups A, B, C, and D; these data are shown in table 1 9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] . There are considerable differences between some studies, which can be attributed to many factors, including the study design and inclusion criteria, how the patients were recruited (e.g.…”

“…GOLD C comprised 13%, reflecting a general trend for this category to be a minority of the population. It should be noted that studies comparing the use of CAT and mMRC have generally shown an increase in severity towards more GOLD B and D patients using CAT 11,16,20,21 , indicating that these tools do not provide equivalent results.…”