Abstract
BackgroundThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV1). This allows patients to change to less severe COPD stages, a novel aspect of assessment not previously evaluated. We aimed to investigate the association between temporal changes in GOLD severity stage and outcomes in COPD patients.MethodsThis was a record-linkage study using patients registered with a Scottish regional COPD network 2000–2015. Annual spirometry & symptoms were recorded and linked to healthcare records to identify exacerbations, hospitalisations and mortality. Spirometry, modified Medical Research Council (mMRC) dyspnoea scale and acute exacerbations over the previous year were used to assign GOLD severity at each visit. A time-dependent Cox model was used to model time to death. Secondary outcomes were respiratory specific mortality and hospitalisations. Effect sizes are expressed as Hazard Ratios HR (95%CI).ResultsFour thousand, eight hundred and eighty-five patients (mean age 67.3 years; 51.3% female) with 21,348 visits were included. During a median 6.6 years follow-up there were 1530 deaths. For the secondary outcomes there were 712 respiratory deaths and 1629 first hospitalisations. Across 16,463 visit-pairs, improvement in COPD severity was seen in 2308 (14%), no change in 11,010 (66.9%) and worsening in 3145 (19.1). Compared to patients staying in GOLD stage A, those worsening had a stepwise increased mortality and hospitalisations.ConclusionsImproving COPD severity classification was associated with reduced mortality and worsening COPD severity was associated with increased mortality and hospitalisations. Change in GOLD group has potential as monitoring tool and outcome measure in clinical trials.
Highlights
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV1)
Unlike the 2007 Global initiative for Obstructive Lung Disease (GOLD) chronic obstructive pulmonary disease (COPD) severity stages that were based solely on Forced Expiratory Volume in one second (FEV1), the subsequent (2011 and beyond) GOLD COPD strategy statements classified COPD severity into distinct groups based on symptoms and exacerbations as well as spirometry (Fig. 1) [1, 2]
In keeping with previous studies, we show that over half patients’ severity stage remains stable [10]. Looking at those patients over time we show that GOLD stage A patients who remain in that stage have the best outcomes in terms of hospitalisations and mortality
Summary
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV1). This allows patients to change to less severe COPD stages, a novel aspect of assessment not previously evaluated. Unlike the 2007 Global initiative for Obstructive Lung Disease (GOLD) chronic obstructive pulmonary disease (COPD) severity stages that were based solely on Forced Expiratory Volume in one second (FEV1), the subsequent (2011 and beyond) GOLD COPD strategy statements classified COPD severity into distinct groups based on symptoms and exacerbations as well as spirometry (Fig. 1) [1, 2]. Previous studies have looked into the stability of the new GOLD stages [8,9,10]; the relationship between change in GOLD stage and patients’ hospitalisations and mortality remained unclear especially as they move in between COPD severity stages several times over time
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