Distribution and Prognostic Validity of the New Global Initiative for Chronic Obstructive Lung Disease Grading Classification

Soriano, Joan B.; Alfageme, Inmaculada; Almagro, Pere; Casanova, Ciro; Esteban, Cristóbal; Soler-Cataluña, Juan José; de-Torres, Juan P.; Martínez‐Camblor, Pablo; Miravitlles, Marc; Celli, Bartolomé R.; Marı́n, José Marı́a

doi:10.1378/chest.12-1053

Cited by 126 publications

(151 citation statements)

References 29 publications

Supporting

Mentioning

123

Contrasting

Unclassified

Order By: Relevance

“…[5,7,19] According to our data, differences are found between our study groups with a cutoff of 6.2 years, which suggests that cohorts should have longer follow-ups if we wish to adequately establish the variability in FEV 1 decline. [20]…”

Section: Discussionmentioning

confidence: 99%

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Lόpez-Campos

Fernández-Villar

Represas-Represas

et al. 2017

European Clinical Respiratory Journal

View full text Add to dashboard Cite

Background: COPD is a chronic disease traditionally associated with increased symptoms as lung function deteriorates. Follow-up times in previous cohort studies were limited to a few years. Interestingly, newer longer observational studies show a more comprehensive picture on disease progression over time. Therefore, the question on the relevancy of the follow-up time in cohort studies remains open. Methods: The ON-SINT study is an observational, retrospective, nationwide, real-life cohort study, in which patients diagnosed with COPD were recruited between December 2011 and April 2013 by primary care (PC) and secondary care (SC) physicians. Patients were evaluated at the inclusion visit and at the initial visit when the diagnosis of COPD was first established. Distribution of lung function decline over the years was studied comparing those cases with longer follow-up times, with the median of the distribution as the cutoff point. Results: The sample included 1214 patients of which 857 (70.6%) were recruited by PC and 357 (29.4%) by SC physicians. Median follow-up time was 6.26 years. Mean annual change in the complete cohort were –4.5 (222) ml year–1 for FVC and 5.5 (134) ml year–1 for FEV1. We confirm the variable distribution of FEV1 decline and found that longer follow-up periods reduce this variability. Of note, FEV1 decline was different between groups (shorter: 19.7 [180.4] vs longer: –9.7 [46.9]; p = 0.018). Further, our data revealed differences in the clinical presentation according to follow-up times, with special emphasis on dyspnea (OR: 1.035; 95%CI: 1.014–1.056), exacerbations (OR 1.172; 95%CI 1.045–1.315) and CAT scores (OR 1.047; 95%CI 1.019–1.075) being associated with longer follow-up times. Conclusions: This study describes the impact of follow-up periods on lung function variability, and reveals differences in clinical presentation according to follow-up times, with special emphasis on dyspnea, exacerbations and CAT scores.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Lόpez-Campos

Fernández-Villar

Represas-Represas

et al. 2017

European Clinical Respiratory Journal

View full text Add to dashboard Cite

show abstract

“…Analysis of cohort data from four large studies [58][59][60][61] suggests that there is considerable variability between the prevalence of the four GOLD groups. Findings are influenced by the population involved.…”

Section: Gold Recommendations and Patient Subgroupsmentioning

confidence: 99%

Addressing unmet needs in the treatment of COPD

Patalano¹,

Banerji²,

D’Andrea³

et al. 2014

Eur Respir Rev

View full text Add to dashboard Cite

The burden of chronic obstructive pulmonary disease (COPD) is considerable, both socially and economically. Central to COPD management is the use of long-acting bronchodilators, which provide patients with optimal bronchodilation and improvements in symptoms. The once-daily, long-acting b 2 -agonist indacaterol, the long-acting muscarinic antagonist glycopyrronium, and the indacaterol/glycopyrronium fixed-dose combination QVA149 have all been shown to significantly improve lung function and patientreported outcomes. The ability to take medication appropriately is important. Easy to use, low resistance devices may help patients take their medication and achieve good drug deposition. There is a need to optimise COPD management by treating the right patients with the right therapy at the right time during the course of their disease. Herein, we present a view on the current COPD management landscape and current unmet needs, and look to the future of COPD treatment and how patient care can be optimised. @ERSpublications There is a need to optimise COPD treatment, with the aim of improving patients' lives

show abstract

“…Efforts to improve clinical staging or predict future outcomes will add other risk factors, such as age and smoking history, to an index of lung function. A GOLD update added history of exacerbations and symptoms to the FEV1 percent predicted cut-off points shown above, but this did not improve its prognostic validity [10,21] The BODE index added body mass index, a dyspnoea score and walking distance [22]. Other candidates include frailty [23], phenotypes [24,25] and biomarkers [26,27].…”

mentioning

confidence: 99%

Assessment of severity and prognosis in COPD: moving beyond percent of predicted

Culver

2018

Eur Respir J

View full text Add to dashboard Cite

@ERSpublicationsNewer methods of grading severity of airflow limitation perform better than the percent predicted of the FEV1 and deserve consideration in both prognostic models and individual patient assessment http://ow.ly/oQB030kvVEWCite this article as: Culver BH. Assessment of severity and prognosis in COPD: moving beyond percent of predicted. Eur Respir J 2018; 52: 1801005 [https://doi.org/10.1183/13993003.01005-2018.There is broad consensus that airflow limitation, the primary physiological abnormality of chronic obstructive pulmonary disease (COPD), is best defined by a significant reduction in the ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) or to the slow vital capacity. There is also abundant evidence that this reduction is most accurately identified as an individual value less than the lower limit of the normal range (LLN) specific to that individual, as determined from an appropriate healthy, non-smoking, reference population [1]. Because the FEV1/FVC ratio declines normally with age, using a non-individualised cut-off, such as 0.70, has been shown to cause an unacceptable level of misclassification with age and sex bias; this leads to over-diagnosis of 30% or more of older men and under-diagnosis of younger women [2][3][4][5]. There is much less consensus, however, on methods to indicate disease severity or to assess the likelihood of future outcomes. The most commonly used index is the percent of the predicted value of FEV1, with various cut-off points proposed for categories of severity, and this was endorsed in the 2005 American Thoracic Society (ATS)/European Respiratory Society (ERS) pulmonary function documents [1]. The use of standardised residuals (z-scores) to establish the normal range was recommended by the ERS in 1993 [6] and, more recently, they have also been evaluated as an index of severity [7]. Their use in pulmonary function reporting, particularly as part of a visual scale, has been endorsed in a current ATS technical statement [8]. Both percent of predicted and z-score depend upon the predicted value of FEV1, but predicted values have inherent uncertainty and may not accurately reflect some individuals. Other indices, based upon the absolute value of FEV1, and thus not dependent upon a reference value, have been proposed but are not yet in wide use. Recently in the European Respiratory Journal, HUANG et al. [9] reported an evaluation of seven methods to categorise reductions in FEV1, comparing their correlations to the outcomes of acute exacerbations and mortality. While this study in a Taiwanese population with confirmed COPD was relatively small (n=296) and predominantly male (94%), the results draw attention to some of the less commonly used indices and may cause us to rethink our dependence on percent of predicted.For each of the methods studied, the population was divided into four stages of severity and the reliability of the index was assessed by the correlation of these strata to increasingly worse outcomes. This analysis tests both the ...

show abstract

Distribution and Prognostic Validity of the New Global Initiative for Chronic Obstructive Lung Disease Grading Classification

Cited by 126 publications

References 29 publications

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Evaluation of clinical variables according to follow-up times in COPD: results from ON-SINT cohort

Addressing unmet needs in the treatment of COPD

Assessment of severity and prognosis in COPD: moving beyond percent of predicted

Contact Info

Product

Resources

About