Impact of changing GOLD guidelines (2007–2011–2017) on assignment of a COPD patient to disease severity category

Abstract

Introduction: The international standard for the recognition and treatment of chronic obstructive pulmonary disease (COPD) is guided by a regularly updated set of criteria developed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Aim: To investigate the impact of updated COPD management guidelines from 2007 to 2017 (GOLD 2007, GOLD 2011 and GOLD 2017) on the assignment of patients into individual therapeutic groups, examining both individual and population dimensions. Material and methods: Each of 500 randomly chosen primary care physicians in Poland provided information on 10 individual COPD patients (disease history, clinical status, treatment and pharmacotherapy). This data was used to simulate the consequences of the implementation of the GOLD 2007, 2011 and 2017 guidelines. Results: A group of 298 physicians of 500 approached provided information on 2597 patients (64.2% males) aged 29-96 (61.6 ±11.1 years). Based on GOLD 2007 guidelines, most patients (56.7%) presented a severe stage of COPD. GOLD 2011 updates would significantly increase the proportion of patients with the most severe stage of disease, and this group would be predominantly classified as moderate or severe in GOLD 2007. The implementation of GOLD 2017 guidelines would result in a significant migration of patients towards the lightest (category A) form of the disease. Conclusions: Updates to the GOLD 2007 COPD guidelines for GOLD 2011 and 2017 would have a significant impact on the classification of patients for particular therapeutic groups. As a result of the migration of patients to particular therapeutic groups, the pharmacological treatment would also change.

Comparison of Immediate and Sequential Withdrawal of a Systemic Glucocorticoid in the Treatment of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Multicenter, Randomized, Double-Blind, Parallel-Controlled, Open-Label Study

“…Thus, the study was expanded to identify the relevant indicators. The GOLD was developed to spread awareness of COPD as a major public health problem and facilitate its prevention and treatment ( Nowak et al, 2020 ). To explore the effect of the GOLD on patient prognosis, patients were divided into high or low GOLD grade groups, and the difference was significant ( P < 0.05).…”

Costs of pharmacotherapy of chronic obstructive pulmonary disease in relation to changing Global Initiative for Chronic Obstructive Lung Disease 2007-2011-2017 guidelines

“…9,12,13 As a result of the reclassification of patients to particular therapeutic groups, the pharmacological regimen used in those patients would also change. 9 The change in the frequency of use of individual drug groups affects the costs of pharmacotherapy of COPD patients. Our study showed that the update from the 2007 guidelines to 2011 and 2017 guidelines would significantly change the cost of drugs used in the treatment of COPD with the costs from 2007 being the highest and comparable to those in 2011, while the costs from 2017 were significantly lower.…”

“…9 These data were used to inform a retrospective simulation analysis, in which the 3 sets of the GOLD guidelines (2007, 2011, and 2017) were applied to each patient's data to predict COPD severity stage for each subject, using the 3 classification schemes as previously described. 9 Changes in the assignment of a COPD patient to a specific category of clinical disease severity following application of the 2011 and 2017 GOLD guidelines were described in detail in a previous article 9 and were the basis of the current analysis to predict costs. Recommended COPD pharmacotherapy regimens were determined, also based on the 3 sets of the 2007, 2011, and 2017 guidelines.…”