Global Initiative For Chronic Obstructive Lung Disease Classification Research Articles

Blood eosinophils levels in a Colombian cohort of biomass-and tobacco-related COPD patients.

Chronic obstructive pulmonary disease (COPD) is a major cause of illness and death among adults. In 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy incorporated blood eosinophils as a biomarker to identify patients at increased risk of exacerbations which, with the history of exacerbations during the previous year, allows identification of patients who would benefit from anti-inflammatory treatment to reduce the risk of future exacerbations. The aim of this study was to describe demographic and clinical characteristics, eosinophil counts, and exacerbations in a cohort of COPD patients stratified by clinical phenotypes (non-exacerbator, frequent exacerbator, asthma-COPD overlap) in a Colombian cohort at 2600 meters above sea level. A descriptive analysis of a historical cohort of patients with a confirmed diagnosis of moderate to severe COPD (FEV1/FVC < 0.7 and at least one risk factor for COPD) from two specialized centers with comprehensive disease management programs was performed from January 2015 to March 2019. Data were extracted from medical records 1 year before and after the index date. 200 patients were included (GOLD B: 156, GOLD E: 44; 2023 GOLD classification); mean age was 77.9 (SD 7.9) years; 48% were women, and 52% had biomass exposure as a COPD risk factor. The mean FEV1/FVC was 53.4% (SD 9.8), with an FEV1 of 52.7% (20.7). No differences were observed between clinical phenotypes in terms of airflow limitation. The geometric mean of absolute blood eosinophils was 197.58 (SD 2.09) cells/μL (range 0 to 3,020). Mean blood eosinophil count was higher in patients with smoking history and frequent exacerbators. At least one moderate and one severe exacerbation occurred in the previous year in 44 and 8% of patients, respectively; during the follow-up year 152 exacerbations were registered, 122 (80%) moderate and 30 (20%) severe. The highest rate of exacerbations in the follow-up year occurred in the subgroup of patients with the frequent exacerbator phenotype and eosinophils ≥300 cells/μL. In this cohort, the frequency of biomass exposure as a risk factor is considerable. High blood eosinophil count was related to smoking, and to the frequent exacerbator phenotype.

Application of the ERS/ATS Spirometry Standards and Race-Neutral Equations in the COPDGene Study.

The European Respiratory Society (ERS) and the American Thoracic Society (ATS) recommend using z-scores, and the ATS has recommended using Global Lung Initiative (GLI)- "Global" race-neutral reference equations for spirometry interpretation. However, these recommendations have been variably implemented and the impact has not been widely assessed, both in clinical and research settings. We evaluated the ERS/ATS airflow obstruction severity classification. In the COPDGene Study (n = 10,108), airflow obstruction has been defined as a forced expiratory volume in one second to forced vital capacity (FEV1/FVC) ratio <0.70, with spirometry severity graded from class 1 to 4 based on race-specific percent predicted (pp) FEV1 cut-points as recommended by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We compared the GOLD approach, using NHANES III race-specific equations, to the application of GLI-Global equations using the ERS/ATS definition of airflow obstruction as FEV1/FVC ratio < lower limit of normal (LLN) and z-FEV1 cut-points of -1.645, -2.5, and -4 ("zGLI Global"). We tested the four-tier severity scheme for association with COPD outcomes. The lowest agreement between ERS/ATS with zGLI Global and the GOLD classification was observed in individuals with milder disease (56.9% and 42.5% in GOLD 1 and 2) and race was a major determinant of redistribution. After adjustment for relevant covariates, zGLI Global distinguished all-cause mortality risk between normal spirometry and the first grade of COPD (Hazard Ratio 1.23, 95% CI 1.04-1.44, p=0.014), and showed a linear increase in exacerbation rates with increasing disease severity, in comparison to GOLD. The zGLI Global severity classification outperformed GOLD in the discrimination of survival, exacerbations, and imaging characteristics.

Comparison of Disease Severity Classifications of Chronic Obstructive Pulmonary Disease: GOLD vs. STAR in Clinical Practice.

In chronic obstructive pulmonary disease (COPD), there are two known classifications for assessing what is called disease severity. One is the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, which is based on the post-bronchodilator value of FEV1 (% reference). The other is the STaging of Airflow obstruction by Ratio (STAR), with four grades of severity in subjects with an FEV1/FVC ratio <0.70: STAR 1 ≥0.60 to <0.70, STAR 2 ≥0.50 to <0.60, STAR 3 ≥0.40 to <0.50, and STAR 4 <0.40. The aim of this study was to compare the staging of COPD using the GOLD and STAR classifications in clinical practice. We reanalyzed data from our outpatient cohort study, which included 141 participants with COPD from 2015 to 2023. We compared mortality and COPD-specific health status between the GOLD 1 to 4 groups and the STAR 1 to 4 groups. By simple calculation, GOLD and STAR severity classes coincided in 75 participants (53.2%). The weighted Bangdiwala B value with linear weights was 0.775. The participants were observed for up to 95 months, with a median of 54 months. Death was confirmed in 29 participants (20.5%). In univariate Cox proportional hazards analyses, there was a significant difference in mortality between the GOLD 1 and GOLD 3 + 4 groups, with the GOLD 1 group used as the reference [hazard ratio 4.222 (95% CI 1.298-13.733), p = 0.017]. However, there was no statistically significant predictive relationship between STAR 1 and STAR 2, or between STAR 1 and STAR 3 + 4. St. George's Respiratory Questionnaire (SGRQ) Total and COPD Assessment Test (CAT) scores were significantly different between all GOLD groups, except for the CAT score between GOLD 1 and GOLD 2. The SGRQ Total and CAT scores were significantly different between STAR 1 and STAR 3 + 4, but not between STAR 1 and STAR 2. From the perspective of all-cause mortality and COPD-specific health status, the GOLD classification is more discriminative than STAR.

Efficacy of different respiratory supports to prevent hypoxia during flexible bronchoscopy in patients of COPD: a triple-arm, randomised controlled trial

BackgroundPatients with chronic-obstructive-pulmonary-disease (COPD) undergo bronchoscopy for various reasons, and are at relatively higher risk of complications. This study evaluated the efficacy of non-invasive ventilation (NIV) and high-flow-oxygen-therapy (HFOT) compared...

Frailty phenotype in chronic obstructive pulmonary disease patients: prevalence and relation to disease severity

Frailty is considered a high risk for falls, disability, hospitalization, and mortality in geriatric and certain chronic-disease populations. So, this study was planned to determine the prevalence of frailty phenotype in Chronic obstructive pulmonary disease (COPD) patients. Methods. 70 stable COPD patients were included in this study. Age, comorbidities (The FRAIL (Fatigue, Resistance, Ambulation, Illness, and Loss of weight) scale, BODE index, and modified Medical Research Council dyspnea score (mMRC) were recorded. In addition, each patient performed the Six-minute walk test (6-MWT) and underwent a pulmonary function test. Results. Frailty was detected in 37.3% of studied patients. However, 43.1% were classified as pre-frail. The presence of frailty was not significantly associated with the age of studied patients (p = 0.7). Comorbidities were significantly associated with frailty (p = 0.009). Also, the BODE index was significantly higher among patients with frailty (p &lt; 0.001). Frailty was significantly associated with forced expiratory volume in 1 second, residual lung volume/Total Lung Capacity, and GOLD (Global Initiative for Chronic Obstructive Lung Disease) classification of COPD (p = 0.001; p = 0.003; p = 0.003 respectively). Frailty was significantly associated with 6-MWD and Borg scale difference (Lowest 6-MWD, highest Borg scale difference were detected in frail patients (p = 0.008; p = 0.001). Conclusion. Frailty is frequent among COPD patients. The presence of frailty is related to disease severity and functional impairment. Evaluation of frailty should be considered as a part of COPD assessment in clinical practice.

Differences in physical function, self-efficacy, and health-related quality of life by disease severity in community-dwelling patients with chronic obstructive pulmonary disease

Purpose: This study investigated the differences in physical function, self-efficacy (SE), and health-related quality of life (HRQoL) categorized by disease severity in community-dwelling patients with chronic obstructive pulmonary disease (COPD). Methods: This cross-sectional study included 182 patients with COPD selected from the pulmonology outpatient department of a tertiary hospital. Disease severity was measured using forced expiratory volume in 1 second (FEV1). Physical function, SE, and HRQoL were measured with the six-minute walking distance, pulmonary rehabilitation self-efficacy (PRAISE), and St. George's Respiratory Questionnaire (SGRQ). Disease duration, FEV1, and 12-month history of exacerbations were obtained from medical records. Patients were categorized by Global Initiative for Chronic Obstructive Lung Disease (GOLD) category. Data were analyzed using the two-sample t-test, χ2 test, and one-way ANOVA. Results: Most of the participants were male and nonsmokers. The disease duration was 10.76 ± 10.03 years, the mean FEV1% was 62.13 ± 22.80, and 70.3% of the participants were in GOLD category 2 (moderate) or milder. Half of the participants reported modified Medical Research Council scores ≥ 2. Patients in GOLD categories 1 and 3 (mild and severe) exhibited significantly higher PRAISE scores than those in the other groups (F = 8.23, p &lt; .001). The total SGRQ scores were highest in GOLD 4 (very severe), indicating the lowest HRQoL. Significant differences were identified among GOLD 1, GOLD 2 and 3, and GOLD 4 (F = 9.92, p &lt; .001). Conclusion: We identified potentially useful variables to comprehensively assess disease severity and tailor management strategies, including airflow limitation, and to determine the consequences of COPD from patients’ perspectives.

Race-Specific Spirometry Equations Do Not Improve Models of Dyspnea and Quantitative Chest CT Phenotypes

Race-specific spirometry reference equations are used globally to interpret lung function for clinical, research, and occupational purposes, but inclusion of race is under scrutiny. Does including self-identified race in spirometry reference equation formation improve the ability of predicted FEV1 values to explain quantitative chest CT abnormalities, dyspnea, or Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification? Using data from healthy adults who have never smoked in both the National Health and Nutrition Survey (2007-2012) and COPDGene study cohorts, race-neutral, race-free, and race-specific prediction equations were generated for FEV1. Using sensitivity/specificity, multivariable logistic regression, and random forest models, these equations were applied in a cross-sectional analysis to populations of individuals who currently smoke and individuals who formerly smoked to determine how they affected GOLD classification and the fit of models predicting quantitative chest CT phenotypes or dyspnea. Race-specific equations showed no advantage relative to race-neutral or race-free equations in models of quantitative chest CT phenotypes or dyspnea. Race-neutral reference equations reclassified up to 19%of Black participants into more severe GOLD classes, while race-neutral/race-free equations may improve model fit for dyspnea symptoms relative to race-specific equations. Race-specific equations offered no advantage over race-neutral/race-free equations in three distinct explanatory models of dyspnea and chest CT scan abnormalities. Race-neutral/race-free reference equations may improve pulmonary disease diagnoses and treatment in populations highly vulnerable to lung disease.

Assessment of Medication Regimen Complexity of COPD Regimens in Individuals Visiting Community Pharmacies.

Non-adherence is common and linked to poor COPD outcomes. Medication Regimen Complexity Index (MRCI) scores affect other disease outcomes. Little is known about the implications of MRCI scores in COPD. Secondary analysis was done to calculate MRCI scores assessing relationship to symptoms, COPD severity and health literacy (HL) to identify potential interventions to optimize adherence. Secondary analysis was conducted of cross-sectional, non-randomized survey data. Participants with self-reported COPD completed a survey of demographics, exacerbations, symptoms (COPD Assessment Test (CAT)), and self-reported COPD regimens. COPD severity was classified into Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD categories using exacerbation history and CAT. CAT scores were categorized as low (<10), high (>10) and very high (>20). A 1-year proportion of days covered (PDC) was calculated. A MRCI calculator scored regimens (primary endpoint). Published cut-off points were used to categorize MRCIs as low (≤4), medium (5-8) and high (>8) and inhaled device polypharmacy (IDP) as ≥3 devices. Risk for low HL was assessed using a Single Item Literacy Screener. Descriptive and Chi-squared statistics were used. Participants' (N = 709) PDC for 1 maintenance medicine averaged 0.43 ± 0.37; 28.7% were adherent (PDC ≥ 80%). CAT scores were very high in 54.6% and high in 35.8%. Distribution of GOLD categories were A (6%), B (35%), C (4%) and D (55%). High, medium and low MRCI were 85%, 14% and 9%, respectively. Mean devices per regimen was 2.05 ± 0.8; IDP was 28%. MRCI and IDP increased with worsening CAT scores and COPD severity per GOLD category (p<0.05), but not low HL. MRCI scores for COPD regimens increased with COPD severity and symptoms. Overall adherence was low despite high symptom scores; high MRCI scores could contribute. All COPD medication classes are available in multiple devices, combinations, and daily formulations; there is potential to simplify regimens. Prospective studies are needed to evaluate if interventions minimizing MRCI scores improve adherence and COPD outcomes.

FEV1/FVC Severity Stages for Chronic Obstructive Pulmonary Disease.

The diagnosis of COPD is based on low ratio of the forced expiratory volume in one second to the forced vital capacity (FEV1/FVC) but its severity is classified using percentage predicted FEV1 (ppFEV1). To test a new severity classification scheme for COPD using FEV1/FVC, a more robust measure of airflow obstruction than ppFEV1. In COPDGene (n=10,132), the severity of airflow obstruction was categorized by GOLD Stages I-IV (ppFEV1 ≥80, ≥50-80, ≥30-50, and <30). A new severity classification (STaging of Airflow obstruction by Ratio, STAR) was tested in COPDGene: FEV1/FVC ≥0.60 to <0.70, ≥0.50 to <0.60, ≥0.40 to <0.50, and <0.40, respectively for stages I-IV, and applied to the combined Pittsburgh SCCOR and Pittsburgh Emphysema registry cohorts for replication (n=2017). Agreement (weighted Bangdiwala B) between GOLD and new FEV1/FVC severity stages was 0.89 in COPDGene and 0.88 in the Pittsburgh cohort. In both COPDGene and the Pittsburgh cohort, in comparison to GOLD staging, STAR provided significant discrimination between the absence of airflow obstruction and Stage I for all-cause mortality, respiratory-quality of life, dyspnea, airway wall thickness, exacerbations and lung function decline. No difference was noted for emphysema, small airways disease, and 6-minute walk distance. The STAR classification system identified a greater number of adults with Stage III-IV disease who would be eligible for lung transplantation and lung volume reduction evaluations. The new severity classification scheme STAR provides discrimination for mortality similar to the GOLD classification but with a more uniform gradation of disease truncated.

Stabil KOAH vakalarının izlem ve değerlendirmesinde hangisi daha değerli; CRP mi, Eozinofil mi, Lökosit mi?

Objective:COPD(Chronic obstructive pulmonary disease) is a disease characterized by chronic inflammation with exacerbations.It is known that inflammatory markers such as CRP(C-reactive protein), eosinophils and leukocytes can be variable in exacerbations of COPD and should be followed-up.In this study,the relationships of CRP, eosinophil, leukocyte levels with the number of exacerbations/prognosis were investigated in COPDpatients.&#x0D; Methods:Data from stable COPD patients were analyzed in the study. CRP, eosinophil and leukocyte levels were measured. PFT was performed, CAT(COPD Assesment Test), m-MRC(Modified Medical Research Council) scores were calculated. The relationships between the number of exacerbations, CAT and m-MRC scores and CRP, eosinophil and leukocyte levels of the patients were evaluated. Correlation analysis, ANOVA and X2 tests were used in the analyses.&#x0D; Results:The mean age of the stable 151 COPD patients was 66.1 years and 84.8% were male. The annual number of exacerbations is 1.9±5.1. Eosinophil level was found to be high in 9.9% of cases, this rate was 4.7% for CRP. Leukocyte level was found to be high in 20.5% of cases. The correlations between the CRP,eosinophil and leukocyte levels and the m-MRC, CAT score, GOLD(Global Initiative for Chronic Obstructive Lung Disease) classification, the number of exacerbations were examined. There was no significant correlation between CRP and eosinophil levels and these parameters. Positively, significant correlation was found between leukocyte level and both m-MRC, CAT scores and number of exacerbations. Similarly, it was found that the proportion of patients with "high leukocyte levels" increased in patients with high number of exacerbations, m-MRC and CAT scores(p

Factors affecting the length of stay and hospital readmission rates after an acute exacerbation of chronic obstructive pulmonary disease: a systematic review and meta-analysis.

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are often readmitted to hospital for treatment due to an acute exacerbation of the disease. However, there are few up-to-date studies investigating the lengths of stay and risk factors for readmission after an acute exacerbation of COPD. This study evaluated the length of stay in patients with an acute exacerbation of COPD and the factors that influenced their readmission.MethodsA search of the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases, carried out using the following search terms: airflow limitation, airway disease, airway obstruction, chronic obstructive pulmonary disease, COPD, length of stay and influencing factors, long-term oxygen therapy, lung disease, readmission, and respiratory system disease. The Cochrane risk of bias tool was used to evaluate the quality of the retrieved studies, and a network meta-analysis was performed using RevMan 5.20.ResultsCollectively, they included information on the length of stay for 630 patients who had been readmitted to hospital after an acute exacerbation of COPD (the readmitted group) and information on 688 patients who had not been readmitted (the non-readmitted group). Meta-analysis results showed that there was no difference in patient anxiety [risk ratio (RR) 1.22, 95% confidence interval (CI): 0.70–2.14] or long-term oxygen therapy (RR 1.91, 95% CI: 0.98–3.73) between the readmitted group and the non-readmitted group. However, there was a significant difference between the forced expiratory volume in one second (FEV1) predicted value [mean difference (MD) −5.85, 95% CI: −11.14 to −0.57] and the global initiative for chronic obstructive lung disease (GOLD) classification (C or D) (RR 1.61, 95% CI: 1.05–2.47).DiscussionIn summary, no significant relationship was found between patient state of anxiety, long-term oxygen therapy, length of hospital stay, and readmission rate after an acute exacerbation of COPD. However, FEV1 predicted values and GOLD classifications (C or D) had an impact on the length of hospital stay and readmission rate after acute exacerbation of COPD. Larger samples, multiple centers, and further research are needed to confirm the findings of this research.

Value of Cardiopulmonary Exercise Testing in the Prognosis Assessment of Chronic Obstructive Pulmonary Disease Patients: A Retrospective, Multicentre Cohort Study

Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases associated with high mortality. Previous studies suggested a prognostic role for peak oxygen uptake (VO₂peak) assessed during cardiopulmonary exercise testing (CPET) in patients with COPD. However, most of these studies had small sample sizes or short follow-up periods, and despite their relevance, CPET parameters are not included in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) tool for assessment of severity. Objectives: We therefore aimed to assess the prognostic value of CPET parameters in a large cohort of outpatients with COPD. Methods: In this retrospective, multicentre cohort study, medical records of patients with COPD who underwent CPET during 2004–2017 were reviewed and demographics, smoking habits, GOLD grade and category, exacerbation frequency, dyspnoea score, lung function measurements, and CPET parameters were documented. Relationships with survival were evaluated using Kaplan-Meier analysis, Cox regression, and receiver operating characteristic (ROC) curves. Results: Of a total of 347 patients, 312 patients were included. Five-year and 10-year survival probability was 75% and 57%, respectively. VO₂peak significantly predicted survival (hazard ratio: 0.886 [95% confidence interval: 0.830; 0.946]). The optimal VO₂peak threshold for discrimination of 5-year survival was 14.6 mL/kg/min (area under ROC curve: 0.713). Five-year survival in patients with VO₂peak <14.6 mL/kg/min versus ≥ 14.6 mL/kg/min was 60% versus 86% in GOLD categories A/B and 64% versus 90% in GOLD categories C/D. Conclusions: We confirm that VO₂peak is a highly significant predictor of survival in COPD patients and recommend the incorporation of VO₂peak into the assessment of COPD severity.

An Evaluation of quantitative body composition on thoracic computed tomography and the effect on clinical severity in patients with chronic obstructive pulmonary disease

The aim of this study was to evaluate the effect on disease severity of the quantitative measurements of pectoral muscle area (PMA), pectoral muscle index (PMI), pectoral muscle density (PMD), subcutaneous adipose tissue (SAT) and mediastinal adipose tissue (MAT) taken on thoracic computed tomography (CT) of patients with chronic obstructive pulmonary disease (COPD), according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification. A retrospective screening was made of patients diagnosed with COPD and applied with thoracic CT and respiratory function tests. For patients with obstructive findings, a record was made of height, weight, body mass index, and smoking history (packet/year). On thoracic axial CT images, the PMA, PMI, PMD, SAT, and MAT values at the aortic arch level were calculated quantitatively using OsiriX software (Pixmeo, Switzerland). The patients were grouped as A-B-C-D according to the GOLD 2018 guidelines. Then two groups were formed as mild-moderate COPD (GOLD A-B) and severe COPD (GOLD C-D). The relationship was evaluated between clinical severity and quantitative body composition values according to the GOLD classification. A total of 80 patients diagnosed with COPD were included in the study comprising 61 males and 19 females. The GOLD A-B group included 43 (53.75%) patients and the GOLD C-D group, 37 (46.25%) patients. No significant difference was determined between the two groups in respect of the PMA, PMI, and PMD values (p=0.001). A statistically significant difference was determined between the groups in respect of the SAT and MAT values (p=0.001, p=0.002, respectively). A cutoff value of &lt;30.04 in PMD (0.964; 95%CI:0.928-1) showed the best performance in predicting the mild-moderate COPD patients (GOLD A-B) with 92% sensitivity and 93% specificity. The results of this study demonstrated that PMD showed the best quantitative body composition performance in the differentiation of mild-moderate and severe COPD disease.

Procalcitonin-Guided Antibiotic Prescribing for Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the Emergency Department.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be caused by viral, bacterial, or environmental factors. Recent studies have suggested that procalcitonin serum levels may help reduce unnecessary antibiotic use without statistically significant differences in rates of treatment failure for AECOPD. The purpose of this quality improvement project was to create a procalcitonin-based algorithm to aid emergency department (ED) clinicians in the management of patients with AECOPD who do not require hospitalization and to evaluate its efficacy and practicality. The primary outcome of this project was the rate of antibiotic prescriptions before and after the initiation of the algorithm. This study used an observational, retrospective, pre-and posteducation/intervention design. Clinicians were educated individually on the use of procalcitonin, and a copy of the algorithm was made available to each clinician and posted in the ED. Patients who were discharged from the ED with a diagnosis of an AECOPD were identified using International Classification of Diseases, Tenth Revision codes. Patient charts were reviewed from November 2018 to March 2019 for the preimplementation period and November 2019 to March 2020 for the postimplementation period. The rate of antibiotic prescriptions and the number of procalcitonin tests ordered before and after the introduction of the algorithm were analyzed. In addition, information on COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) grouping and 30-, 60-, and 90-day reexacerbation rates were collected. It was estimated that a sample size of 146 patients (73 patients/group) would provide 80% power to detect a between-group difference of 10% in the percentage of patients who were prescribed antibiotics. Categorical variables were expressed using estimates of their frequency and percentages. Percentages were compared using Fisher exact tests. For all tests, the significance level was set at 0.05. Seventy-three patients were included in the preintervention group, and 77 patients were included in the postintervention group. Patients in the preintervention and postintervention groups had similar representation in GOLD categories: 52% and 51% for D, 17.8% and 23.4% for C, 21.9% and 16.8% for B, and 8.2% and 7.8% for A, respectively. The rate of antibiotic prescriptions decreased by 20% after implementation from 83.6% before to 63.6% after implementation (P = .01). The differences in reexacerbation rates between the preintervention and postintervention groups were similar: 19.2% vs 23.4% at 30 days, 12.3% vs 11.7% at 60 days, and 4.1% vs 9.1% at 90 days, respectively. Prior to education and introduction of the procalcitonin algorithm, procalcitonin was ordered for 1.4% of AECOPD cases. Postimplementation, procalcitonin was ordered for 28.6% of AECOPD cases and used in clinical decision making 81.8% of the time. In this study of the implementation of a treatment algorithm for patients with mild and moderate AECOPD who present to the ED, procalcitonin was shown to reduce the rate of antibiotic prescriptions without an observable difference in reexacerbation rates 30, 60, and 90 days after presentation.

A Comparative Evaluation of Computed Tomography Images for the Classification of Spirometric Severity of the Chronic Obstructive Pulmonary Disease with Deep Learning.

Recently, deep learning applications in medical imaging have been widely applied. However, whether it is sufficient to simply input the entire image or whether it is necessary to preprocess the setting of the supervised image has not been sufficiently studied. This study aimed to create a classifier trained with and without preprocessing for the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification using CT images and to evaluate the classification accuracy of the GOLD classification by confusion matrix. According to former GOLD 0, GOLD 1, GOLD 2, and GOLD 3 or 4, eighty patients were divided into four groups (n = 20). The classification models were created by the transfer learning of the ResNet50 network architecture. The created models were evaluated by confusion matrix and AUC. Moreover, the rearranged confusion matrix for former stages 0 and ≥1 was evaluated by the same procedure. The AUCs of original and threshold images for the four-class analysis were 0.61 ± 0.13 and 0.64 ± 0.10, respectively, and the AUCs for the two classifications of former GOLD 0 and GOLD ≥ 1 were 0.64 ± 0.06 and 0.68 ± 0.12, respectively. In the two-class classification by threshold image, recall and precision were over 0.8 in GOLD ≥ 1, and in the McNemar–Bowker test, there was some symmetry. The results suggest that the preprocessed threshold image can be possibly used as a screening tool for GOLD classification without pulmonary function tests, rather than inputting the normal image into the convolutional neural network (CNN) for CT image learning.

The Correlation of Sit-to-Stand Tests with COPD Assessment Test and GOLD Staging Classification

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD classification tool has been used to assess the symptom burden and exacerbation risk of patients with chronic obstructive pulmonary disease (COPD). An area requiring further exploration is the relationship between the GOLD classification's basic components and the measurements acquired by Sit-to-Stand tests (STST). We aimed to study the relationship between STST and the component of the GOLD classification tool. This study was conducted on a sample of 42 COPD subjects with patient history, COPD assessment test (CAT) and spirometry. 5STST performance time and the number 30s-STST repetitions showed differences of statistical significance in COPD subjects considered to be more symptomatic and in subjects with high risk of future exacerbations. Both STSTs correlated significantly with forced expiratory volume in one second % predicted (FEV1%), CAT, number of acute exacerbations in the past year and number of hospitalized exacerbations in the past year. STST performance correlates significantly with items of the CAT questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy. Using multivariate analysis, age, FEV1% and CAT score manifested the strongest negative association with STST performance. 5STST performance time and the number 30s-STST repetitions in COPD patients correlates with the level of symptoms and the risk of future exacerbations that define groups A-D based on GOLD 2018 classification tool (at the time of data acquisition). The correlation of STST performance with CAT score involves specific items of the questionnaire that assess breathlessness, limitation of activities, confidence and lack of energy.

How to Stage Airflow Limitation in Stable Chronic Obstructive Pulmonary Disease Male Patients?

No study has evaluated the utility of different classifications of chronic obstructive pulmonary disease (COPD) airflow limitation (AFL) in terms of the refined “ABCD” classification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) or in terms of the impacts on quality of life. This study aimed to compare some relevant health outcomes (i.e., GOLD classification and quality-of-life scores) between COPD patients having “light” and “severe” AFL according to five COPD AFL classifications. It was a cross-sectional prospective study including 55 stable COPD male patients. The COPD assessment test (CAT), the VQ11 quality-of-life questionnaire, a spirometry, and a bronchodilator test were performed. The patients were divided into GOLD “A/B” and “C/D.” The following five classifications of AFL severity, based on different post-bronchodilator forced expiratory volume in 1 s (FEV1) expressions, were applied: FEV1%pred: “light” (≥50), “severe” (<50); FEV1z-score: “light” (≥−3), “severe” (<−3); FEV1/height2: “light” (≥0.40), “severe” (<0.40); FEV1/height3: “light” (≥0.29), “severe” (<0.29); and FEV1Quotient: “light” (≥2.50), “severe” (<2.50). The percentages of the patients with “severe” AFL were significantly influenced by the applied classification of the AFL severity (89.1 [FEV1z-score], 63.6 [FEV1%pred], 41.8 [FEV1/height3], 40.0 [FEV1Quotient], and 25.4 [FEV1/height2]; Cochrane test = 91.49, df = 4). The CAT and VQ11 scores were significantly different between the patients having “light” and “severe” AFL. In GOLD “C/D” patients, only the FEV1Quotient was able to distinguish between the two AFL severities. To conclude, the five classifications of COPD AFL were not similar when compared with regard to some relevant health outcomes.

Evaluation of severity of chronic obstructive pulmonary disease using bronchial obstruction, dyspnea, exercise index and global initiative for chronic obstructive lung disease classification and it’s correlation with physical quality of life measured by St. George’s respiratory disease questionnaire score

Background: The Global initiative for chronic Obstructive Lung Disease (GOLD) criteria classified chronic obstructive pulmonary disease (COPD) by severity into four stages. Recently, Body mass index (BMI), Bronchial Obstruction, Dyspnea, Exercise (BODE) index, was proposed to provide useful prognostic information of COPD patients. Health-related quality of life (HRQOL) is measured by St. George’s Respiratory disease Questionnaire (SGRQ). Study was undertaken to assess correlations between BODE index and GOLD classification with SGRQ score.Methods: Fifty five COPD patients were included. Spirometry was performed in all patients. Modified Medical Research Council (mMRC) scale was used to label severity of dyspnea. Six-minute walking distance (6 MWD) was performed. BODE index was calculated by giving points to BMI, forced expiratory volume in one minute (FEV1), 6 MWD, and mMRC. SGRQ was used to determine HRQOL. Correlation analysis was done using Pearson’s method.Results: Mean symptoms, mean activity, mean impacts and mean total SGRQ score were significantly higher in patients having mMRC scale 0-1, patients who could walk ≤149 meters, and in patients who had GOLD III and IV class. Lesser the FEV1, higher the mMRC grade, and lesser the 6 MWD, worse was the quality of life. BODE index (r = 0.72) and GOLD classification (r =0.59) were significantly and positively correlated with symptoms score, activity score, impacts score and total SGRQ score.Conclusions: BODE index correlated better than the Gold classification with SGRQ score implying that apart from the airflow limitation, functional impairment measured by the 6MWT and mMRC also affect HRQOL.

Glycopyrrolate/Formoterol Fumarate Metered Dose Inhaler Improves Lung Function versus Monotherapies in GOLD Category A Patients with COPD: Pooled Data from the Phase III PINNACLE Studies.

BackgroundThe Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends a short-acting bronchodilator or single long-acting bronchodilator as an initial pharmacological treatment for GOLD category A patients with COPD. We pooled data from the PINNACLE-1, -2, and -4 studies to evaluate the efficacy and safety of the dual bronchodilator fixed-dose combination glycopyrrolate/formoterol fumarate metered dose inhaler (GFF MDI), formulated using co-suspension delivery technology, in GOLD category A patients with moderate-to-very severe COPD.Materials and MethodsPINNACLE-1, -2, and -4 were Phase III, randomized, double-blind, parallel-group, multicenter studies (NCT01854645, NCT01854658, and NCT02343458). Patients received 24 weeks’ treatment with GFF MDI 18/9.6 µg, glycopyrrolate (GP) MDI 18 µg, formoterol fumarate (FF) MDI 9.6 µg, or placebo MDI twice daily. GOLD category A patients were identified based on a COPD Assessment Test score of <10 and exacerbation history in the previous year (none/one not requiring hospitalization). Endpoints evaluated were change from baseline in morning pre-dose trough forced expiratory volume in 1 second (FEV1), peak change from baseline in FEV1 within 2 hrs post-dose, and adverse events (AEs).ResultsThe pooled intent-to-treat population comprised 729 GOLD category A patients. GFF MDI significantly improved morning pre-dose trough FEV1 at Week 24 versus GP MDI, FF MDI, and placebo MDI (least squares mean [LSM] differences 54 mL, 62 mL, and 188 mL, respectively; all p≤0.0053), and peak FEV1 at Week 24 versus GP MDI, FF MDI, and placebo MDI (LSM differences 124 mL, 104 mL, and 307 mL, respectively; all p<0.0001). Improvements over 24 weeks were comparable to at Week 24. The AE profile of GFF MDI in GOLD category A patients was similar to monocomponents and placebo MDI.ConclusionGFF MDI significantly improved lung function versus monocomponents and placebo MDI in GOLD category A patients with moderate-to-very severe COPD, with no unexpected safety findings.

Classification of Patients with COPD on LAMA Monotherapy Using the GOLD Criteria: Analysis of a Claims-Linked Patient Survey Study.

IntroductionTo address the burden of chronic obstructive pulmonary disease (COPD), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends treatment according to classification of patients by symptom severity and exacerbation risk. This post hoc analysis of a previously reported claims-linked, cross-sectional survey [study 205862 (HO-16-16642)] classified patients with COPD receiving long-acting muscarinic antagonist (LAMA) monotherapy based on the GOLD 2017 categories.MethodsEligible patients who were ≥ 40 years of age, with ≥ 2 claims with International Classification of Diseases-10th Revision-Clinical Modification COPD diagnosis codes J40–J44 ≥ 30 days apart during the 12-month baseline period, and ≥ 2 claims for LAMA monotherapy in the 6 months prior to identification, were identified using claims data from the Optum Research Database. Patients completed a survey assessing modified Medical Research Council (mMRC) Dyspnea Scale and COPD Assessment Test (CAT) scores and demographics; clinical characteristics were assessed from claims and survey data, while exacerbation history was assessed from claims data. GOLD symptom severity classifications were low (groups A and C) for patients with low scores on both the CAT and mMRC scales (scores of < 10 and 0–1, respectively), and high (groups B and D) for patients with high scores on either scale (scores of ≥ 10 and 2–4, respectively).ResultsOf 433 patients included, 85.5% reported a CAT total score ≥ 10, and 45.5% reported mMRC grades 2–4. During the baseline period, 63.7% of patients had ≤ 1 moderate and 0 severe (hospitalized) exacerbations, and 36.3% had ≥ 1 severe or ≥ 2 moderate exacerbation(s). The proportions of patients with each GOLD classification were: A: 9.0%; B: 54.7%; C: 4.6%; D: 31.6%.ConclusionsIn this population, over 85% of LAMA monotherapy users have symptoms and/or exacerbation risk that may necessitate therapy escalation according to 2017 GOLD guidelines.FundingGlaxoSmithKline [study 205862 (HO-16-16642)].