Comparison of the 2017 and 2015 Global Initiative for Chronic Obstructive Lung Disease Reports. Impact on Grouping and Outcomes

López, Carlos Cabrera; Macario, Ciro Casanova; Trigo, José María Marín; de-Torres, Juan P.; Torres, Rebeca Sicilia; González, Jesús María Martínez; Polverino, Francesca; Divo, Miguel; Plata, Víctor Pinto; Zulueta, Javier; Celli, Bartolomé R.

doi:10.1164/rccm.201707-1363oc

Cited by 67 publications

(61 citation statements)

References 26 publications

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“…None of these studies included the GOLD 2007 classification. Similar to our study, a study by Cabrera Lopez et al 10 observed that all-cause mortality was better predicted by the GOLD 2011 than by the GOLD 2017 classification. In contrast to our study, Gedebjerg et al 9 found that the three GOLD classifications did not differ significantly in predicting respiratory and all-cause mortality.…”

Section: Discussionsupporting

confidence: 92%

“…Similar results to our study have been observed by other studies. 9,10 The PLATINO study showed no clear pattern for all-cause mortality across the categories of the GOLD 2017 classification. 34 No previous studies had investigated COPD hospitalization in relation to the GOLD 2017 classification.…”

Section: Discussionmentioning

confidence: 99%

“…4 Since the publication of the GOLD 2017 classification, the prognostic value of this classification has been debatable with less clear findings. [9][10][11][12] To our knowledge, only one study has compared all three GOLD classifications and found that the GOLD 2017 classification predicted respiratory and all-cause mortality similarly well as the GOLD 2007 and GOLD 2011 classifications. 9 No previous studies have investigated the risk of COPD hospitalization using the GOLD 2017 classification or compared their discrimination ability with the previous GOLD classifications to predict COPD hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Bhatta¹,

Leivseth²,

Mai³

et al. 2020

COPD

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These authors contributed equally to this workPurpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods: We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995)(1996)(1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results: Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (p trend =0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion: The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Bhatta¹,

Leivseth²,

Mai³

et al. 2020

COPD

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“…The characteristics of group A are in line with previous studies in which group A was younger, had a higher proportion of current smokers, and had higher pulmonary function. 5,6 The pharmacotherapy of group A was poorly documented in previous studies. 5,6 In the current study, we demonstrated that the proportion of monotherapy of long-acting bronchodilators was larger in group A than that in groups B-D. Based on the above characteristics, group A has plenty of room for management improvements such as smoking cessation and combination therapy of long-acting bronchodilators.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of GOLD 2017 COPD Group A: A Multicenter Cross-Sectional CAP Study in Japan

Oishi

Hirano

Hamada

et al. 2019

B44. Copd: Treatment and Other Topics

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The 2017 GOLD ABCD classification shifts patients from groups C-D to A-B. Group A was the most widely distributed group in several studies. It would be useful to understand the characteristics for group A patients, but little has been reported concerning these issues. Patients and methods: This was a multicenter cross-sectional study using the COPD Assessment in Practice study database from 15 primary or secondary care facilities in Japan. We investigated the clinical characteristics of group A by stratification according to a mMRC grade 0 or 1. Results: In 1,168 COPD patients, group A patients accounted for approximately half of the patients. Compared with the groups B-D, group A was younger and had a higher proportion of males, higher pulmonary function, and higher proportion of monotherapy with long-acting muscarinic antagonist or long-acting β-agonist. The prevalence of mMRC grade 1 patients was about two-thirds of group A. Compared with the mMRC 0 patients, mMRC 1 patients showed a tendency to have a higher proportion of exacerbations (P=0.054) and had a significantly lower pulmonary function. Regardless of the mMRC grade, 60% of group A patients were treated with monotherapy of long-acting muscarinic antagonist or long-acting β-agonist. Conclusion: Group A patients accounted for approximately half of the patients, and they were younger, had higher pulmonary function, and had lower pharmacotherapy intensity compared with groups B-D. By stratifying according to the mMRC grade 0 or 1 in group A patients, there were differences in the exacerbation risk and airflow limitation.

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“…Interestingly, when analysing the distribution of patients according to GOLD 2016 criteria, the great majority of high‐risk patients were classified as such according to lung function . Therefore, the GOLD 2017 classification would be expected to shift a considerable number of previously high‐risk patients to the low‐risk category . A quantitative analysis of data from previous cohort studies supports this expectation (Fig.…”

Section: Step Down From Triple Therapy To Double Bronchodilationmentioning

confidence: 75%

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

et al. 2018

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The implementation of potential new step-up or step-down treatment recommendations in response to current guidelines is one of the main challenges currently faced in actual daily practice settings. In the present narrative review, we aim to discuss the relevance of these step-up and step-down proposals at the patient level in daily clinical practice. In particular, we aim to review the challenges associated with inhaled maintenance therapy for chronic obstructive pulmonary disease (COPD) in four clinical scenarios. First, we discuss the step up from single to double bronchodilation, including current controversies regarding the addition of a second bronchodilator versus initial treatment with two bronchodilators. Second, we discuss the step up from double bronchodilation to triple therapy while challenging current indications for inhaled steroid therapy and discussing triple therapy designs. Third, we discuss the step down from triple therapy to double bronchodilation while evaluating the effect of this downshift in risk categories on the patient according to the new classifications. Finally, we discuss the step down from double to single bronchodilation, with a special focus on safety. We believe this review will help to highlight the most relevant discussion points regarding the treatment of COPD in a manner that will stimulate and guide related clinical research.

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Comparison of the 2017 and 2015 Global Initiative for Chronic Obstructive Lung Disease Reports. Impact on Grouping and Outcomes

Cited by 67 publications

References 26 publications

<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Characteristics of GOLD 2017 COPD Group A: A Multicenter Cross-Sectional CAP Study in Japan

Current controversies in the stepping up and stepping down of inhaled therapies for COPD at the patient level

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