Burden of Disease in Patients with Mild or Mild-to-Moderate Chronic Obstructive Pulmonary Disease (Global Initiative for Chronic Obstructive Lung Disease Group A or B): A Systematic Literature Review

Abstract

Background

Patients with mild or mild-to-moderate chronic obstructive pulmonary disease (COPD), defined as Global Initiative for Chronic Obstructive Lung Disease (GOLD) group A/B, are regarded as having a lower risk of experiencing multiple or severe exacerbations compared with patients classified as GOLD group C/D. Current guidelines suggest that patients in GOLD A/B should commence treatment with a bronchodilator; however, some patients within this population who have a higher disease burden may benefit from earlier introduction of dual bronchodilator or inhaled corticosteroid-containing therapies. This study aimed to provide research-based insights into the burden of disease experienced by patients classified as GOLD A/B, and to identify characteristics associated with poorer outcomes.

Methods

A systematic literature review (SLR) was conducted to identify evidence (burden of disease and prevalence data) relating to the population of interest (patients with COPD classified as GOLD A/B).

Results

A total of 79 full-text publications and four conference abstracts were included. In general, the rates of moderate and severe exacerbations were higher among patients in GOLD group B than among those in group A. Among patients classified as GOLD A/B, the risk of exacerbation was higher in those with more symptoms (modified Medical Research Council or COPD Assessment Test scales) and more severe airflow limitation (forced expiratory volume in 1 second % predicted).

Conclusion

Data from this SLR provide clear evidence of a heavier burden of disease for patients in GOLD B, compared with those in GOLD A, and highlight factors associated with worse outcomes for patients in GOLD A/B.

Keywords:

• COPD Assessment Test
• COPD
• disease burden
• GOLD A/B
• modified Medical Research Council
• systematic review

Data Sharing Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

Institutional review board/ethics approval was not required for this study. No personal subject contact or primary collection of individual human data occurred.

Acknowledgments

Editorial support (in the form of writing assistance, including preparation of the draft manuscript under the direction and guidance of the authors, collating and incorporating authors’ comments for each draft, assembling tables and figures, grammatical editing, and referencing) was provided by Rebecca Cunningham of Aura, a division of Spirit Medical Communications Group Limited (Manchester, UK), and was funded by GSK.

Author Contributions

All authors have made significant contributions to the work of the report, whether in terms of concept, research design, implementation, data acquisition, analysis and interpretation, or in all these areas; participate in the drafting, modification, or critical review of the clause; final approval of the forthcoming edition; an agreement has been reached on the journal to submit the article; and agree to be responsible for all aspects of the work.

Disclosure

Alexandrosz Czira, Kieran J. Rothnie, Chris Compton, and Afisi S Ismaila are employees of, and/or hold stocks/shares in, GSK. Afisi S Ismaila is also an unpaid part-time member of the McMaster University faculty in Canada. Sneha Purushotham and Ike Iheanacho are employees of Evidera. Evidera received funding from GSK to conduct the study. The authors report no other conflicts of interest in this work.

Additional information

Funding

This study was funded by GSK (study number 214854). The sponsor was involved in the study design, data analysis and interpretation, the writing of the report, and the decision to submit the article for publication. The sponsor was also given the opportunity to review the manuscript for medical and scientific accuracy, as well as intellectual property considerations.