GOLD 2017 on the way to a phenotypic approach? Analysis from the Phenotypes of COPD in Central and Eastern Europe (POPE) Cohort

Tudorić, Neven; Koblížek, Vladimír; Miravitlles, Marc; Valipour, Arschang; Milenković, Branislava; Barczyk, Adam; Somfay, Attila; Zykov, K. A.; Kostov, Kosta; Zbožínková, Zuzana; Svoboda, Michal; Sorli, J; Krams, Alvils; Tkáčová, Ružena

doi:10.1183/13993003.02518-2016

Cited by 31 publications

(40 citation statements)

References 8 publications

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“…Tudoric et al showed that in the revised A-B-C-D classification, about half of the patients in Group C of the 2011 GOLD were reclassified into Group A, and more than one-third of those formerly in Group D were reclassified into Group B according to the 2017 GOLD. 10 Similar conclusions were arrived at in a study by Sun et al 11 But two other studies showed that more than half of the patients in both Groups C and D were reclassified into low-risk groups. 12 , 13 This was slightly different from the change in distribution found in this study, with the difference mainly due to the lower proportion of people being redistributed into Group B.…”

Section: Discussionsupporting

confidence: 73%

“… 9 At the same time, some patients with COPD originally categorized as Groups C and D were reclassified into Groups A and B. Two previous studies on 2017 GOLD classification showed that the new grading system resulted in large changes in the demographic characteristics of patients with COPD distributed in the four categories, ie, A, B, C, and D. 10 , 11 Two other studies arrived at similar conclusions, except for slightly different distributions among the groups. 12 , 13 At the same time, a study by Marçoa et al indicated that patients in Group B of the new grading system had a higher risk of acute exacerbations than the old classification.…”

Section: Introductionmentioning

confidence: 79%

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Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China

Hu¹,

Liang²,

Xu³

et al. 2018

COPD

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ObjectiveCompared with the 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD), there have been significant changes in the 2017 GOLD classification. The purpose of this study was to analyze the changes in clinical characteristics of the new A-B-C-D system and to explore its role in comprehensive assessment of COPD.Subjects and methodsA total of 631 stable COPD patients were included in a cross-sectional survey. Data collected included baseline data and pulmonary function testing results, respiratory muscle strength, symptoms and quality of life, exercise capacity, nutritional status, and anxiety and depression as a comprehensive assessment. Based on the 2011 GOLD and 2017 GOLD classifications, patients were divided into Groups A1–D1 and Groups A2–D2, respectively.ResultsIn the 2011 GOLD, 64 subjects in Group C1 were reclassified into Group A2 (41.6%), while 77 subjects in Group D1 were reclassified into Group B2 (27.1%). The old and new grading systems were somewhat consistent (Cohen’s kappa=0.6963, P<0.001). Lung function was lower, while the body mass index, airflow obstruction, dyspnea, and exercise capacity index (BODE index) was higher in Group A2 than in Group A1 (P<0.001). In Group B2, lung function, 6-minute walking distance (6MWD), and respiratory muscle strength were significantly lower than in Group B1 (P<0.001), while the BODE index (P<0.001) was higher. In comprehensive assessment, subjects in Groups B2 and D2 had significantly lower lung function, 6MWD, respiratory muscle strength, quality of life, higher symptom scores, and BODE index than subjects in Group A2 (P<0.001). The differences between Group A2 and C2 were small.ConclusionCompared with the 2011 GOLD, the 2017 GOLD reclassified more patients into Groups A and B, those with significantly worse lung function and higher BODE index. In the comprehensive assessment of the new classification, Groups B and D may have greater disease severity. However, the effectiveness of the new grading system in predicting patient prognosis, and its guidance on the use of drugs, remains to be explored in future studies.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 79%

Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China

Hu¹,

Liang²,

Xu³

et al. 2018

COPD

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“…Neven Tudoric et al also showed according to the revised ABCD classification, more than a third of patients formerly classified as “D” and almost half of patients formerly classified as “C” solely on the basis of poor lung function moved from the high-risk groups to the low-risk groups. 16 GOLD 2017 shifted the overall COPD severity distribution to milder categories.…”

Section: Discussionmentioning

confidence: 99%

Changes in definition lead to changes in the clinical characteristics across COPD categories according to GOLD 2017: a national cross-sectional survey in China

L¹,

Chen²,

Wu³

et al. 2017

COPD

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PurposeTo investigate how the changes of definition in assessment of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stratification 2017 lead to changes of chronic obstructive pulmonary disease (COPD) patient clinical characteristics across categories in China.Patients and methodsCOPD patients from 11 medical centers in China were stratified into old and new groups A–D twice according to the GOLD 2011 and 2017 comprehensive assessment. Demography and clinical characteristics were compared between old and new groups A–D.ResultsIn 1,532 COPD patients, the distribution from group A to D was 330 (21.5%), 132 (8.6%), 411 (26.8%), 659 (43.0%) and 557 (36.4%), 405 (26.4%), 184 (12.0%), 386 (25.2%), respectively according to GOLD 2011 and 2017. 46.7% (500/1,070) patients in high-risk groups were regrouped to low-risk groups. Compared to the old groups A and B, the new groups A and B had a higher proportion of males, lower body mass index, higher modified Medical Research Council (mMRC) grade, poor pulmonary function, more patients with chronic bronchitis, and fewer patients with coronary heart disease and hypertension disease. Compared to the old groups C and D, the new groups C and D had older patients, fewer men, better pulmonary functions, frequent acute exacerbations in the previous year, and more patients with chronic bronchitis, coronary heart disease, or diabetes mellitus. The new group D had more patients with stroke than the old group D.ConclusionIn China, GOLD 2017 shifted the overall COPD comprehensive assessments distribution to more low-risk groups. The new high-risk groups had more characteristics associated with high risk of acute exacerbation and mortality. Some of the changes in demography and clinical characteristics of the new low-risk groups were associated with high risk of acute exacerbation and/or mortality.

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“…Indeed, a recent analysis from a cohort of 3,500 patients with stable COPD in Central and Eastern Europe 99 showed that 35% of patients in group D according to the previous version of the GOLD guidelines 100 would move to group B according to the GOLD 2017 revision, because of a lack of real exacerbations. 101 Of note, the majority of these patients (71%) were on ICS treatment, and according to GOLD 2017 should not receive ICSs any longer. It remains to be determined whether and to what extent the guideline recommendations on the use of ICS-containing regimens will be translated into real-life prescription behavior.…”

Section: The Effect Of Bronchodilators On Exacerbation Rates In Copdmentioning

confidence: 99%

Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

Ariel¹,

Altraja²,

Белевский³

et al. 2017

COPD

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COPD is a complex, heterogeneous condition. Even in the early clinical stages, COPD carries a significant burden, with breathlessness frequently leading to a reduction in exercise capacity and changes that correlate with long-term patient outcomes and mortality. Implementation of an effective management strategy is required to reduce symptoms, preserve lung function, quality of life, and exercise capacity, and prevent exacerbations. However, current clinical practice frequently differs from published guidelines on the management of COPD. This review focuses on the current scientific evidence and expert opinion on the management of moderate COPD: the symptoms arising from moderate airflow obstruction and the burden these symptoms impose, how physical activity can improve disease outcomes, the benefits of dual bronchodilation in COPD, and the limited evidence for the benefits of inhaled corticosteroids in this disease. We emphasize the importance of maximizing bronchodilation in COPD with inhaled dual-bronchodilator treatment, enhancing patient-related outcomes, and enabling the withdrawal of inhaled corticosteroids in COPD in well-defined patient groups.

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GOLD 2017 on the way to a phenotypic approach? Analysis from the Phenotypes of COPD in Central and Eastern Europe (POPE) Cohort

Cited by 31 publications

References 8 publications

Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China

Comparison of the clinical characteristics and comprehensive assessments of the 2011 and 2017 GOLD classifications for patients with COPD in China

Changes in definition lead to changes in the clinical characteristics across COPD categories according to GOLD 2017: a national cross-sectional survey in China

Inhaled therapies in patients with moderate COPD in clinical practice: current thinking

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