Differences in outcomes between GOLD groups in patients with COPD in the TIOSPIR® trial

Abstract

BackgroundThe aim of this study was to evaluate whether Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification could predict mortality risk factors and whether baseline treatment intensity would relate to mortality within each group, using data from TIOSPIR®, the largest randomized clinical trial in COPD performed to date.MethodsA total of 17,135 patients from TIOSPIR® were pooled and grouped by GOLD grading (A–D) according to baseline Medical Research Council breathlessness score, exacerbation history, and spirometry. All-cause mortality and adjudicated cardiovascular (CV) and respiratory mortality were assessed.ResultsOf the 16,326 patients classified, 1,248 died on treatment. Group B patients received proportionally more CV treatment at baseline. CV mortality risk, but not all-cause mortality risk, was significantly higher in Group B than Group C patients (CV mortality – hazard ratio [HR] =1.74, P=0.004; all-cause mortality – HR =1.18, P=0.11). Group D patients had a higher incidence of all-cause mortality than Group B patients (10.9% vs 6.6%). Similar trends were observed regardless of respiratory or CV medication at baseline. In contrast, respiratory deaths increased consistently from Groups A–D (0.3%, 0.8%, 1.6%, and 4.2% of patients, respectively).ConclusionThe data obtained from the TIOSPIR® trial, supporting earlier studies, suggest that proportionally more CV medication and CV deaths occur in GOLD Group B COPD patients, although deaths attributed to respiratory causes are more prevalent in Groups C and D.

Causes of hospitalization and characteristics of Algerian chronic obstructive pulmonary disease patients in Tizi-Ouzou: a retrospective study

“…Unexpectedly, less than 22 % of the admitted patients were in GOLD stage I/II and were hospitalized for different reasons including chest pain, cancer, decompensation, heart disease, dyspnea and infections. This reinforces the fact that those in these GOLD classes are vulnerable and at risk of exacerbation and death despite having better spirometry [21]. Another interesting study, reported a shift from the 2007 1-4 GOLD classification to the 2011 A-D classification.…”

COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD

“…Patients with severe to very severe COPD have worse health status [2], higher risk of hospitalised exacerbations, higher acute care burdens [1,3] and higher mortality rates than patients with mild to moderate disease [4][5][6][7]. This was also shown in the TIOSPIR (Tiotropium Safety and Performance in Respimat) trial, where the risks of respiratory-related deaths and hospitalised exacerbations were greater in GOLD (Global Initiative for Obstructive Lung Disease) C or D patients than in GOLD A patients [8]. Better control of exacerbation frequency and severity could slow disease progression and reduce hospitalisation [9,10], especially in patients with severe COPD who encounter difficulties in managing their disease on a daily basis.…”

Comparison of COPD patients on single inhaler and two separate inhalers for triple therapy – A short duration prospective cohort study

“…Treatment outcome would be poorer if the grade of COPD is poorer. 18 Inhaled steroid and baseline FEV1% favoured a better outcome in the group of patients on single inhaler. All the patients on single inhaler used spacer whereas only 70% of the patients on two inhalers used spacer.…”