GOLD classifications and mortality in chronic obstructive pulmonary disease: the HUNT Study, Norway

Leivseth, Linda; Brumpton, Ben; Nilsen, Tom Ivar Lund; Mai, Xiao-Mei; Johnsen, Roar; Langhammer, Arnulf

doi:10.1136/thoraxjnl-2013-203270

Cited by 73 publications

(73 citation statements)

References 25 publications

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“…One would expect that subjects in this ''marginal zone'' (with FEV1/FVC ,0.70 but .LLN) would develop clinical symptoms and signs of disease, and follow-up studies have shed light on this clinically relevant issue. In longitudinal studies of subjects in this marginal zone no association has been found with increased risk of all-cause mortality [13][14][15]22] (except in symptomatic smokers [16]), development of respiratory symptoms [16], accelerated decline in FEV1 [13,[16][17][18], or with respiratory care utilisation or poorer quality of life scores compared with a reference group [16]. In a review of the literature, MOHAMED HOESEIN et al [23] could only find one publication by MANNINO et al [24] allegedly demonstrating that subjects with an FEV1/(F)VC ratio ,0.70 but .LLN had an increased risk of premature death and hospitalisation for COPD, and on that basis accepted that GOLD grade I does represent respiratory disease.…”

Section: Discussionmentioning

confidence: 99%

“…In view of this the GOLD committee introduced a new classification system that combines spirometry with respiratory symptoms in an attempt to quantify future risk; however, this system had not been previously validated. LEIVSETH et al [22] concluded that GOLD grade 1 was not associated with increased mortality, and that spirometric GOLD grades 2 and higher predicted mortality better than the new GOLD ABCD groups amongst people with COPD from a Norwegian general population. Also, survival is better in the more severe COPD group C (low lung function but less dyspnoea) than in the less severe group B (much better lung function but more dyspnoea) [31], and the addition of dyspnoea and exacerbations to the severity classification did not add prognostic value on long-term COPD outcomes [32].…”

Section: Discussionmentioning

confidence: 99%

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Grading the severity of airways obstruction: new wine in new bottles

et al. 2013

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The objective of this study was to redesign the current grading of obstructive lung disease so that it is clinically relevant and free of biases related to age, height, sex and ethnic group.Spirometric records from 17 880 subjects (50.4% female) from hospitals in Australia and Poland, and 21 191 records (53.0% female) from two epidemiological studies (age range 18-95 years) were analysed. We adopted the American Thoracic Society(ATS)/European Respiratory Society (ERS) criteria for airways obstruction based on an forced expiratory volume in 1 s (FEV1)/(forced) vital capacity ((F)VC) ratio below the fifth percentile and graded the severity of pulmonary function impairment using z-scores for FEV1, which signify how many standard deviations a result is from the mean predicted value.Using the lower limit of normal for FEV1/(F)VC and z-scores for FEV1 of -2, -2.5, -3 and -4 to delineate severity grades of airflow limitation leads to close agreement with ATS/ERS severity classifications and removes age, sex and height related bias.The new classification system is simple, easily memorised and clinically valid. It retains previously established associations with clinical outcomes and avoids biases due to the use of per cent predicted FEV1. Combined with the Global Lung Function prediction equations it provides a worldwide diagnostic standard, free of bias due to age, height, sex and ethnic group. @ERSpublications Using FEV1 z-scores to classify severity of airways obstruction is clinically valid and overcomes bias inherent in % pred

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Grading the severity of airways obstruction: new wine in new bottles

et al. 2013

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“…These mortality studies have consistently shown that group A has the lowest risk, while D has the highest risk. Some studies have shown that group B patients have worse risk compared to group C 9,12,15,22 , giving a risk ordering of A (lowest) -C -B -D (highest), while for other studies the risk ordering is A -B -C -D [17][18][19]27 ; representative survival curves for these two patterns are shown in figure 3. There is evidence that groups B and D have the highest prevalence of patients with cardiovascular comorbidities 14,15 , which presumably contributes to the increased symptoms and also increased mortality risk.…”

Section: Does Combined Assessment Improve Risk Stratification?mentioning

confidence: 99%

“…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.…”

Section: The Combined Assessment Explainedmentioning

confidence: 99%

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

Singh¹,

Ravi²

2016

BRN

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The Global Initiative for Chronic Obstructive Lung Disease (GOLD) advocates a combined assessment of chronic obstructive pulmonary disease using lung function, symptoms, and exacerbation history to categorise patients into group A, B, C, or D. The aims of treatment are to reduce symptoms and prevent future risk, with the choice of treatment tailored according to the category. GOLD promotes an individualised approach to treatment. This review appraises the strengths and potential weaknesses of the current GOLD recommendations for combined assessment and pharmacological treatment of stable chronic obstructive pulmonary disease. There have been a number of recent publications applying the GOLD classification system to different chronic obstructive pulmonary disease populations. What can be learnt from these papers is reviewed, as well as the evidence base for the GOLD recommendations for pharmacological therapy. (BRN Rev. 2016;2:27-39)Corresponding author: Dave Singh, DSingh@meu.org.uk

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“…Both studies failed to demonstrate any difference between the GOLD lung function classification and the ABCD classification in predicting mortality. In contrast, Leivseth et al [7] showed that the ABCD classification was less sensitive in predicting mortality compared to the lung function classification.…”

Section: Introductionmentioning

confidence: 99%

Disability in Moderate Chronic Obstructive Pulmonary Disease: Prevalence, Burden and Assessment - Results from a Real-Life Study

Braido¹,

Baiardini²,

Scichilone³

et al. 2015

Respiration

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Background: The role of disability and its association with patient-reported outcomes in the nonsevere forms of chronic obstructive pulmonary disease (COPD) has never been explored. Objectives: The aim of this study was to assess, in a cross-sectional real-life study, the prevalence and degree of disability in moderate COPD patients and to assess its association with health status, illness perception, risk of death and well-being. Methods: Moderate COPD outpatients attending scheduled visits were involved in a quantitative research program using a questionnaire-based data collection method. Results: Out of 694 patients, 17.4% were classified as disabled and 47.6% reported the loss of at least one relevant function of daily living. Disabled patients did not differ from nondisabled patients in terms of working status (p = 0.06), smoking habits (p = 0.134) and ongoing treatment (p = 0.823); however, the former showed a significantly higher disease burden as measured by illness perception, health status and well-being. The stepwise regression analysis showed that the modified Medical Research Council (mMRC) score was the most relevant factor related to COPD disability (F = 38.248; p = 0.001). Patient stratification was possible according to the forced expiratory volume in 1 s (FEV₁) value and an mMRC score ≥2, which identified disabled patients, whereas the mMRC values were differently associated with the risk of disability. Conclusion: A significant proportion of individuals with moderate COPD reported a limitation of daily life functions, with dyspnea being the most relevant factor inducing disability. Adding the evaluation of patient-reported outcomes to lung function assessment could facilitate the identification of disabled patients.

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GOLD classifications and mortality in chronic obstructive pulmonary disease: the HUNT Study, Norway

Cited by 73 publications

References 25 publications

Grading the severity of airways obstruction: new wine in new bottles

Grading the severity of airways obstruction: new wine in new bottles

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

Disability in Moderate Chronic Obstructive Pulmonary Disease: Prevalence, Burden and Assessment - Results from a Real-Life Study

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