2017 Global Initiative for Chronic Obstructive Lung Disease reclassifies half of COPD subjects to lower risk group

• Published in: International journal of chronic obstructive pulmonary disease 2018-01, Vol.13 (`), p.165-173
• Main Authors: Högman, Marieann, Sulku, Johanna, Ställberg, Björn, Janson, Christer, Bröms, Kristina, Hedenström, Hans, Lisspers, Karin, Malinovschi, Andrei
• Format: Article
• Language: English
• Subjects: Algorithms; Angina pectoris; Antibiotics; Blood; Body mass index; Carbon monoxide; Care and treatment; Chronic obstructive lung disease; Classification; Comorbidity; COPD; eosinophils; GOLD; Hospitals; inhalation treatment; Lung diseases; lung function test; Medical research; Neutrophils; Original Research; Questionnaires; Risk assessment; Spirometry; Steroids; Variance analysis
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/copd.s151016

Unlike the 2014 guidelines, the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have removed lung function from the risk assessment algorithm of patients with COPD. The aim of this investigation was to analyze the proportion of subjects who would change to a lower risk group when applying GOLD and determine if they exhibit different characteristics in terms of inflammation, symptoms and comorbidity compared to the subjects who would remain in a high-risk group. A total of 571 subjects with physician-diagnosed and spirometry-verified COPD were included in the present study. The data consisted of measurements of lung function, inflammatory markers, together with questionnaires that covered comorbidities, COPD symptoms and medication. From group C, 53% of the subjects would be reclassified to the lower risk group A, and from group D, 47% of the subjects would be reclassified to the lower risk group B when using GOLD instead of GOLD . Compared to the subjects who would remain in group D, those who would change to group B were more often men (56% vs 72%); of an older age, mean (SD), 71 (8) years vs 68 (7) years; had more primary care contact (54% vs 33%); had lower levels of blood neutrophils, geometrical mean (95% CI), 5.3 (5.0, 5.7) vs 4.6 (4.3, 4.9); reported less anxiety/depression (20% vs 34%); experienced less asthma (29% vs 46%) and had fewer symptoms according to the COPD assessment test, 16 (5) vs 21 (7). All -values were