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

Figures & data

Figure 1 Flow chart of the inclusion of participants from the central Swedish regions of Dalarna, Gävleborg and Uppsala with the grouping into A–D using GOLD²⁰¹⁴ guidelines.

Abbreviations: FEV₁, forced expiratory volume in 1 second; VCmax, highest vital capacity from slow or forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 1 Characteristics of the subjects assessed by GOLD²⁰¹⁴

GOLD^2014	A	B	C	D	p-value
Subjects, n	155	148	62	206
Female, n (%)	80 (52)	83 (56)	39 (63)	133 (65)	0.07
Age (years)	68 (7)	69 (8)	67 (9)	69 (7)	0.06
Educational level,a n (%)	34 (22)	33 (22)	15 (24)	37 (18)	0.60
Smoking, n (%)	50 (32)	41 (28)	16 (26)	57 (28)	0.71
BMI	26 (4)	28 (5)	26 (5)	26 (6)	<0.001
Comorbidity, n (%)
Asthma	41 (26)	44 (30)	25 (40)	79 (38)	0.048
Chronic bronchitis	20 (13)	55 (37)	15 (24)	103 (50)	<0.001
Heart disease	25 (16)	37 (25)	4 (6)	51 (25)	0.002
Hypertension	62 (40)	77 (52)	23 (37)	115 (56)	0.005
Diabetes	12 (8)	15 (10)	5 (8)	22 (11)	0.80
Anxiety/depression	24 (15)	43 (29)	12 (19)	56 (27)	0.015
Lung function
FEV1 (% predicted)	68 (11)	67 (12)	48 (16)	43 (15)	<0.001
FVC (% predicted)	80 (16)	74 (14)	66 (18)	60 (15)	<0.001
Inflammatory markers
FENO50 (ppb)b	14 (13, 16)	13 (11, 15)	12 (10, 14)	13 (12, 14)	0.28
B-Neu (10^9/L)b	4.4 (4.1, 4.6)	4.4 (4.2, 4.6)	4.7 (4.3, 5.0)	5.0 (4.7, 5.2)	<0.001
B-Eos (10^9/L)b	0.18 (0.16, 0.20)	0.20 (0.18, 0.22)	0.16 (0.13, 0.21)	0.16 (0.14, 0.18)	0.06
Treatment,c n (%)
No treatmentd	58 (37)	37 (25)	9 (15)	16 (8)	<0.001
Bronchodilatorse	42 (27)	40 (27)	7 (11)	24 (12)	<0.001
ICSf	55 (36)	71 (48)	46 (74)	166 (80)	<0.001
Symptom burden
CAT	6 (3)	15 (4)	6 (3)	18 (6)	<0.001
mMRC	0.8 (0.7)	1.7 (1.0)	1.1 (0.8)	2.5 (1.3)	<0.001
CCQ	0.8 (0.5)	1.9 (0.8)	0.9 (0.5)	2.7 (1.1)	<0.001
Exacerbations, n (%)
Any exacerbations	29 (19)	35 (24)	34 (55)	136 (66)	<0.001
Hospital admissions	0 (0)	0 (0)	8 (13)	31 (15)	<0.001

Notes: Data are given in mean (SD).

a Defined as at least 3 years in high school.

b Geometrical mean (95% CI).

c Short-acting β₂-agonist and/or short-acting muscarinic-antagonist possible.

d No treatment or no regular treatment.

e LABA and/or LAMA alone or in combination.

f ICS alone or in any combination with bronchodilators.

Abbreviations: B-Eos, blood eosinophil count; B-Neu, blood neutrophil count; BMI, body mass index; CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; F_ENO₅₀, exhaled nitric oxide at an exhalation flow of 50 mL/s; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; ICS, inhaled corticosteroids; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; mMRC, modified British Medical Research Council.

Figure 2 Change in distribution of subjects assessed with GOLD²⁰¹⁴ and reassessed with GOLD²⁰¹⁷.

Abbreviation: GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Table 2 Characteristics of the subjects that would remain in group C and A and of those that would change to group A using GOLD²⁰¹⁷ instead of GOLD²⁰¹⁴

	Group C changing to group A	Group A remaining in group A	p-valuec	Group C remaining in group C	p-valuec
Subjects, n	33	155		29
Female, n (%)	20 (61)	80 (52)	0.44	19 (66)	0.79
Age (years)	65 (9)	68 (7)	0.06	69 (9)	0.09
Educational level,a n (%)	7 (21)	34 (22)	1	8 (28)	0.77
Smoking, n (%)	9 (27)	50 (32)	0.68	7 (24)	1
BMI	25 (6)	26 (4)	0.25	26 (4)	0.46
Comorbidity, n (%)
Asthma	12 (36)	41 (26)	0.29	13 (45)	0.61
Chronic bronchitis	6 (18)	20 (13)	0.41	9 (31)	0.37
Heart disease	2 (6)	25 (16)	0.18	2 (7)	1
Hypertension	11 (33)	62 (40)	0.56	12 (41)	0.60
Diabetes	3 (9)	12 (8)	0.73	2 (7)	1
Anxiety/depression	6 (18)	24 (15)	0.79	6 (21)	1
Lung function
FEV1 (% predicted)	39 (9)	68 (11)	<0.001	58 (16)	<0.001
FVC (% predicted)	60 (14)	80 (16)	<0.001	72 (19)	0.008
Inflammatory markers
FENO50 (ppb)b	12 (9, 15)	14 (13, 16)	0.13	12 (9, 15)	0.96
B-Neu (10^9/L)b	4.5 (4.0, 5.0)	4.4 (4.1, 4.6)	0.70	4.9 (4.4, 5.4)	0.25
B-Eos (10^9/L)b	0.16 (0.12, 0.20)	0.18 (0.16, 0.20)	0.30	0.18 (0.12, 0.26)	0.57
Symptom burden
CAT	6 (3)	6 (3)	0.73	6 (2)	0.72
mMRC	1.00 (0.75)	0.83 (0.66)	0.17	1.14 (0.83)	0.50
CCQ	0.92 (0.55)	0.80 (0.50)	0.19	0.87 (0.50)	0.66
Exacerbations, n (%)
Any exacerbations	8 (24)	29 (19)	0.47	26 (90)	<0.001
Hospital admissions	0 (0)	0 (0)	1	8 (28)	0.001

Notes: Data are given in mean (SD).

a Defined as at least 3 years in high school.

b Geometrical mean (95% CI).

c Comparison with reference group C changing to group A.

Abbreviations: B-Eos, blood eosinophil count; B-Neu, blood neutrophil count; BMI, body mass index; CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; F_ENO₅₀, exhaled nitric oxide at an exhalation flow of 50 mL/s; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified British Medical Research Council.

Table 3 Characteristics of the subjects that would remain in group D and B and of those that would change to group B using GOLD²⁰¹⁷ instead of GOLD²⁰¹⁴

	Group D changing to group B	Group B remaining in group B	p-valuec	Group D remaining in group D	p-valuec
Subjects, n	96	148		110
Female, n (%)	54 (56)	83 (56)	1	79 (72)	0.03
Age (years)	71 (8)	69 (8)	0.11	68 (7)	0.01
Educational level,a n (%)	21 (22)	33 (22)	1	16 (14)	0.20
Smoking, n (%)	24 (25)	41 (28)	0.66	33 (30)	0.44
BMI	26 (6)	28 (5)	<0.001	27 (6)	0.36
Comorbidity, n (%)
Asthma	28 (29)	44 (30)	1	51 (46)	0.01
Chronic bronchitis	42 (44)	55 (37)	0.35	61 (56)	0.12
Heart disease	19 (20)	24 (25)	0.50	31 (28)	0.19
Hypertension	52 (54)	77 (52)	0.79	63 (57)	0.68
Diabetes	13 (13)	15 (10)	0.42	9 (8)	0.26
Anxiety/depression	19 (20)	43 (29)	0.13	37 (34)	0.03
Lung function
FEV1 (% predicted)	38 (9)	67 (12)	<0.001	48 (18)	<0.001
FVC (% predicted)	59 (14)	74 (14)	<0.001	61 (16)	0.20
Inflammatory markers
FENO50 (ppb)b	13 (11, 16)	13 (11, 15)	0.75	12 (11, 14)	0.51
B-Neu (10^9/L)b	4.6 (4.3, 4.9)	4.4 (4.2, 4.6)	0.23	5.3 (5.0, 5.7)	0.002
B-Eos (10^9/L)b	0.16 (0.14, 0.19)	0.20 (0.18, 0.22)	0.04	0.16 (0.13, 0.18)	0.70
Symptom burden
CAT	16 (5)	15 (4)	0.09	21 (7)	<0.001
mMRC	2.3 (1.2)	1.9 (0.8)	<0.001	2.7 (1.3)	0.01
CCQ	2.4 (1.0)	1.8 (1.1)	<0.001	2.9 (1.2)	<0.001
Exacerbations, n (%)
Any exacerbations	25 (26)	35 (4)	0.79	110 (100)	<0.001
Hospital admissions	0 (0)	0 (0)	1	32 (29)	<0.001

Notes: Data are given in mean (SD).

a Defined as at least 3 years in high school.

b Geometrical mean (95% CI).

c Comparison with reference group D changing to group B.

Abbreviations: B-Eos, blood eosinophil count; B-Neu, blood neutrophil count; BMI, body mass index; CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; F_ENO₅₀, exhaled nitric oxide at an exhalation flow of 50 mL/s; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for Chronic Obstructive Lung Disease; mMRC, modified British Medical Research Council.

Figure 3 Change in distribution of airflow limitations in GOLD²⁰¹⁴ (upper panel) and GOLD²⁰¹⁷ A–D classification (lower panel).

Note: GOLD grade 1 ≥80 FEV₁% predicted, GOLD grade 2 50–79 FEV₁% predicted, GOLD grade 3 30–49 FEV₁% predicted and GOLD grade 4 <30 FEV₁% predicted.
Abbreviations: FEV₁, forced expiratory volume in 1 second; GOLD, Global Initiative for Chronic Obstructive Lung Disease.