The Global Initiative for Chronic Obstructive Lung Disease (GOLD) stratification 2017 initiated changes in chronic obstructive pulmonary disease (COPD) comprehensive assessments distributions to lower-risk groups in China. The new high-risk groups were found to have more characteristics related to acute exacerbation and mortality risks, according to a new study.
In the study
published in International Journal of Chronic Obstructive Pulmonary Disease,
researchers investigated COPD patients from 11 medical centers among 7 provinces in China. The included patients did not demonstrate acute exacerbations and upper respiratory tract infection in the 2 months before the study. Each patient completed a self-administered questionnaire, including the modified Medical Research Council (mMRC) that collected the patients’ demographics and medical history.
The results were categorized with a score in the low-symptom section (A and C) or the high-symptom categories (B and D). The groups based on the GOLD 2011 were considered the old groups and those based on the GOLD 2017 were considered new.
“GOLD 2017 revises the classification system and removes spirometry measure in the categorization, leaving the categorization based on symptoms and frequency of exacerbations. Because of the change of criterion of the assessment tool, patients from high-risk groups (groups C and D) without COPD exacerbation history in the previous year will be shifted to the low-risk groups (groups A and B),” the authors wrote. “We sought to investigate how the changes of definition lead to changes of patient demography and clinical characteristics across categories.”
A total of 1532 patients were included and analyzed in the study. The distribution from A to D was 330 (21.5%), 132 (8.6%), 411 (26.8%), 659 (43.0%), according to GOLD 2011, and 557 (36.4%), 405 (26.4%), 184 (12.0%), 386 (25.2%), according to GOLD 2017. Additionally, 46.7% (500/1070) patients were regrouped from high-risk to low-risk groups.
The new groups A and B had a higher proportion of males, lower body mass index, higher mMRC grade, poor pulmonary function, more patients with chronic bronchitis, and fewer patients with coronary heart disease and hypertension disease than the old groups A and B. The new groups C and D patients were older, had fewer men, better pulmonary functions, frequent acute exacerbations in the previous year, and more patients with chronic bronchitis, coronary heart disease, or diabetes than the old groups. Also, compared to the old group D, the new group had more stroke patients.
Overall, the new high-risk groups had more clinical characteristics associated with a greater risk of acute exacerbations and mortality, while some changes in demography and clinical characteristics of the new low-risk group had this association.
“Clinicians should revisit patient’s current treatment for those patients who are reclassified into low-risk groups. Further research should examine whether treatment de-escalation is appropriate,” concluded the authors.