<p>GOLD Classifications, COPD Hospitalization, and All-Cause Mortality in Chronic Obstructive Pulmonary Disease: The HUNT Study</p>

Abstract

These authors contributed equally to this workPurpose: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) has published three classifications of COPD from 2007 to 2017. No studies have investigated the ability of these classifications to predict COPD-related hospitalizations. We aimed to compare the discrimination ability of the GOLD 2007, 2011, and 2017 classifications to predict COPD hospitalization and all-cause mortality. Patients and Methods: We followed 1300 participants with COPD aged ≥40 years who participated in the HUNT Study (1995)(1996)(1997) through to December 31, 2015. Survival analysis and time-dependent area under receiver operating characteristics curves (AUC) were used to compare the discrimination abilities of the GOLD classifications. Results: Of the 1300 participants, 522 were hospitalized due to COPD and 896 died over 20.4 years of follow-up. In adjusted models, worsening GOLD 2007, GOLD 2011, or GOLD 2017 categories were associated with higher hazards for COPD hospitalization and all-cause mortality, except for the GOLD 2017 classification and all-cause mortality (p trend =0.114). In crude models, the AUCs (95% CI) for the GOLD 2007, GOLD 2011, and GOLD 2017 for COPD hospitalization were 63.1 (58.7-66.9), 60.9 (56.1-64.4), and 56.1 (54.0-58.1), respectively, at 20-years' follow-up. Corresponding estimates for all-cause mortality were 57.0 (54.8-59.1), 54.1 (52.1-56.0), and 52.6 (51.0-54.3). The differences in AUCs between the GOLD classifications to predict COPD hospitalization and all-cause mortality were constant over the follow-up time. Conclusion: The GOLD 2007 classification was better than the GOLD 2011 and 2017 classifications at predicting COPD hospitalization and all-cause mortality.

Daily Vegetables Intake and Response to COPD Rehabilitation. The Role of Oxidative Stress, Inflammation and DNA Damage

“…In recent years, the control of inflammation and DNA damage-associated oxidative stress, together with nutrients intake (as an important part of non-pharmacological strategies, usually with/without physical exercise included), is gaining more and more attention for their possible role in strategies to prevent exacerbations and contrast disease progression. Currently, the standard of care is mostly based on pharmacological interventions, including short-acting bronchodilator drugs (prescribed to patients for immediate relief) and long-acting muscarinic receptor antagonists, beta-2 agonists, or corticosteroids [ 55 ]. The difference in the vegetable intake between responders and non-responders, together with the general improvement in inflammatory levels among COPD patients with high consumption of vegetables and after three weeks of rehabilitation treatment, raises the point of a future consideration of these parameters in the prevention and rehabilitation of COPD patients.…”

Relationship between RS time and the severity of chronic obstructive pulmonary disease

“…COPD has extrapulmonary effects, the most common of which are cardiac effects 17 . Mortality is recognized to increase as the severity of COPD increases 12 . The cause of increased mortality mostly depends on cardiac involvement 11,17 .…”

“…The frequency of cardiac abnormalities is significantly related to the severity of airflow limitation in COPD patients 10,11 . Mortality has also been shown to increase with the severity of airflow limitation in COPD patients 12 . In this research, we intended to explore the relationship between severity of the disease graded by spirometry and RS time in COPD patients to determine whether RS time prolongation could be used to screen COPD patients for the severity of the disease in routine clinical practice.…”

High Vegetables Intake and Response to COPD Rehabilitation Treatment. The Role of Oxidative Stress, Inflammation and DNA Damage

“…In recent years, the control of inflammation and DNA damage-associated oxidative stress, together with nutrients intake (as an important part of non-pharmacological strategies, usually with/without physical exercise included), is gaining more and more attention for their possible role in strategies to prevent exacerbations and contrast disease progression. Currently, the standard of care is mostly based on pharmacological interventions, including short-acting bronchodilator drugs (prescribed to patients for immediate relief) and long-acting muscarine receptor antagonists, beta-2 agonists, or corticosteroids [45]. The difference in the vegetable intake between responders and nonresponders, together with the general improvement in inflammatory levels among COPD patients with high consumption of vegetables and after three weeks of rehabilitation treatment, raises the point of a future consideration of these parameters in the prevention and rehabilitation of COPD patients.…”