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

Abstract

Background

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 GOLD²⁰¹⁷ 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.

Subjects and methods

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.

Results

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 GOLD²⁰¹⁷ instead of GOLD²⁰¹⁴. 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 p-values were <0.05.

Conclusion

The removal of spirometry from risk assessment in GOLD²⁰¹⁷ would lead to the reclassification of approximately half of the subjects in the risk groups C and D to the lower risk groups A and B. There are differences in age, gender, health care contacts, inflammation, comorbidity and symptom burden among those changing from group D to group B. The effects of reclassification and changes in eventual treatment for disease control and symptom burden need further investigation.

Keywords:

• COPD
• lung function test
• eosinophils
• neutrophils
• comorbidity
• GOLD

Acknowledgments

The authors wish to thank the personnel at the Dalarna, Gävleborg and Uppsala research units and Robin Quell for proofreading and editing this manuscript. This study was funded by the Uppsala-Örebro Regional Research Council, Center for Research & Development, Uppsala University/Region Gävleborg, Center for Clinical Research, Uppsala University, County Council Dalarna, The Swedish Heart-Lung Foundation and The Swedish Heart and Lung Association.

Author contributions

MH, JS and AM had full access to the study data and take full responsibility for the integrity of the data and the accuracy of the analysis. MH, AM, BS, KL, CJ, KB and HH contributed to the study design and the writing of the manuscript. All authors contributed toward the data analysis, drafting and critical revision of the paper. All have given final approval of the version to be published and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.