Comparison of the 2017 and 2015 global initiative for chronic obstructive lung disease reports impact on grouping and outcomes

Carlos Cabrera Lopez, Ciro Casanova Macario, José Mará Maŕn Trigo, Juan P. De-Torres, Rebeca Sicilia Torres, Jesus Mará Gonzalez, Francesca Polverino, Miguel Divo, Víctor Pinto Plata, Javier J. Zulueta, Bartolomé Celli

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

Rationale: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) document has modified the grading system directing pharmacotherapy, but how this relates to the previous one from 2015 and to comorbidities, hospitalizations, and mortality risk is unknown. Objectives: The aim of this study was to evaluate the changes in the GOLD groups from 2015 to 2017 and to assess the impact on severity, comorbidities, and mortality within each group. Methods: We prospectively enrolled and followed, for a mean of 5 years, 819 patients with chronic obstructive pulmonary disease (84% male) in clinics in Spain and the United States. We determined anthropometrics, lung function (FEV1%), dyspnea score (modified Medical Research Council scale), ambulatory and hospital exacerbations, and the body mass index, obstruction, dyspnea, and exercise capacity (BODE) and Charlson indexes. We classified patients by the 2015 and 2017 GOLD ABCD system, and compared the differential realignment of the same patients. We related the effect of the reclassification in BODE and Charlson distribution as well as chronic obstructive pulmonary disease and all-cause mortality between the two classifications. Measurements and Main Results: Compared with 2015, the 2017 grading decreased by half the proportion of patients in groups C and D (20.5% vs. 11.2% and 24.6% vs. 12.9%; P < 0.001). The distribution of Charlson also changed, whereas group D was higher than B in 2015, they become similar in the 2017 system. In 2017, the BODE index and risk of death were higher in B and D than in A and C. The mortality risk was better predicted by the 2015 than the 2017 system. Conclusions: Compared with 2015, the GOLD ABCD 2017 classification significantly shifts patients from grades C and D to categories A and B. The new grading system equalizes the Charlson comorbidity score in all groups and minimizes the differences in BODE between groups B and D, making the risk of death similar between them.

Original languageEnglish (US)
Pages (from-to)463-469
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume197
Issue number4
DOIs
StatePublished - Feb 15 2018
Externally publishedYes

Keywords

  • Chronic obstructive pulmonary disease
  • Global Initiative for Chronic Obstructive Lung Disease
  • Prevalence

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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