The impact of 2011 and 2017 Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines on allocation and pharmacological management of patients with COPD in Taiwan: Taiwan Obstructive Lung Disease (TOLD) study

Figures & data

Table 1 Criteria for guideline-concordant and -discordant groups to pharmacological recommendations in GOLD 2011 and 2017 guidelines

Guidelines	Guideline concordant			Guideline discordant
	GOLD 2011		GOLD 2017	GOLD 2011 and GOLD 2017
COPD classifications	First choice	Second choice	Recommended	Undertreatment	Overtreatment
Group A	SABA or SAMA, or SABA/SAMA	LABA or LAMA	SABA or SAMA, or SABA/SAMA, or LABA, or LAMA	Not any bronchodilator	LABA/LAMA, or ICS/LABA, or LAMA/ICS, or ICS/LABA/LAMA
Group B	LABA or LAMA	LABA/LAMA	LABA or LAMA or LABA/ LAMA	SABA, or SAMA, or SABA/SAMA	ICS/LABA, or LAMA/ICS, or ICS/LABA/LAMA
Group C	ICS/LABA or LAMA	LABA/LAMA	LAMA or LABA/LAMA or ICS/LABA	SABA, or SAMA, or SABA/SAMA, or LABA	ICS/LABA/LAMA, or LAMA/ICS
Group D	ICS/LABA or LAMA	ICS/LABA/LAMA, or LABA/LAMA, or LAMA/ICS	LAMA or LABA/LAMA or ICS/LABA, or ICS/LABA/ LAMA, or LAMA/ICS	SABA, or SAMA, or SABA/SAMA, or LABA

Abbreviations: SABA, short acting beta-agonist; SAMA, short-acting muscarinic-antagonist; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; ICS, inhaled corticosteroid.

Table 2 Demographics of COPD patients by the GOLD 2011 grouping system

	Total	Group A	Group B	Group C	Group D	P-value
	N=1,053 (100%)	n=194 (18.4%)	n=428 (40.6%)	n=71 (6.7%)	n=360 (34.2%)	(among A, B, C, D)
Age (years)	72.8±9.6	70.7±10.1	74.6±9.6	69.8±8.6	72.5±9.2	<0.001
BMI (kg/m^2)	23.4±3.9	23.8±3.3	24.0±4.1	23.0±3.5	22.5±3.8	<0.001
Male	995 (94.5%)	182 (93.8%)	400 (93.5%)	69 (97.2%)	344 (95.6%)	0.42
FEV1	1.33±0.57	1.71±0.48	1.53±0.60	1.08±0.33	0.96±0.34	<0.001
FEV1 %pred	58.5±20.5	72.4±15.3	69.0±17.2	44.9±15.1	42.0±13.1	<0.001
mMRC score	1.8±1.0	0.8±0.4	2.1±0.6	0.9±0.5	2.4±0.9	<0.001
CAT score	11.3±7.2	5.3±2.4	12.4±6.5	5.3±2.5	14.4±7.7	<0.001
Exacerbation rates	0.60±1.16	0.13±0.34	0.19±0.40	1.00±1.25	1.27±1.60	<0.001
Smoking history						0.32
Never	97 (9.5%)	14 (7.5%)	44 (10.6%)	6 (8.7%)	33 (9.4%)
Former	590 (57.8%)	99 (52.9%)	235 (56.6%)	43 (62.3%)	213 (60.9%)
Pack-years	42.8±29.2	45.6±32.3	46.4±31.0	48.9±33.6	48.9±32.4
Current	334 (32.7%)	74 (39.6%)	136 (32.8%)	20 (29.0%)	104 (29.7%)
Pack-years	52.2±33.2	45.6±33.0	47.1±29.5	41.8±26.0	49.1±31.1

Abbreviations: FEV₁, forced expiratory volume in the first second; FEV₁%pred, the percentage of FEV₁ of the predicted value; mMRC, modified Medical Research Council; CAT, COPD assessment test.

Figure 1 Changes in distribution of COPD patients according to GOLD 2011 and 2017 guidelines.

Note: C₁ or D₁ (groups C or D patients with FEV₁ <50% predicted, exacerbation ≤1/year and no hospitalized exacerbation).

Table 3 Patterns of maintenance pharmacological therapy according to GOLD 2011 and 2017 grouping systems

COPD classifications	Group A		Group B		Group C		Group D		Total
GOLD treatment, n (%)	2011 194 (18.4%)	2017 245 (23.3%)	2011 428 (40.6%)	2017 666 (63.2%)	2011 71 (6.7%)	2017 20 (1.9%)	2011 360 (34.2%)	2017 122 (11.6%)	1,053 (100%)
Untreated	21 (16.5%)	27 (11.0%)	36 (8.4%)	51 (7.7%)	6 (8.5%)	0 (0.0%)	26 (7.2%)	11 (9.0%)	89 (8.5%)
Maintenance inhalers
LABA	10 (5.2%)	11 (4.5%)	43 (10.0%)	48 (7.2%)	2 (2.8%)	1 (5.0%)	7 (1.9%)	2 (1.6%)	62 (5.9%)
LAMA	67 (34.5%)	80 (32.7%)	116 (27.1%)	164 (24.6%)	16 (22.5%)	3 (15.0%)	66 (18.4%)	18 (14.8%)	265 (25.2%)
LABA/LAMA	7 (3.6%)	11 (4.5%)	29 (6.8%)	39 (5.9%)	5 (7.0%)	1 (5.0%)	16 (4.5%)	6 (4.9%)	57 (5.4%)
ICS/LABA	52 (26.8%)	64 (26.1%)	111 (25.9%)	157 (23.6%)	17 (23.9%)	5 (25.0%)	68 (18.9%)	22 (18.0%)	248 (23.6%)
LAMA/ICS	6 (3.1%)	7 (2.9%)	8 (1.9%)	13 (2.0%)	1 (1.4%)	0 (0.0%)	7 (1.9%)	2 (1.6%)	22 (2.1%)
ICS/LABA/LAMA	20 (10.3%)	34 (13.9%)	82 (19.2%)	191 (28.7%)	24 (33.8%)	10 (50.0%)	170 (47.4%)	61 (50.0%)	296 (28.1%)
ICS	0 (0.0%)	0 (0.0%)	3 (0.7%)	3 (0.5%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	3 (0.3%)
No LABD			39 (8.7%)	54 (8.1%)	8 (11.3%)	0 (0.0%)	33 (9.2%)	11 (9.0%)
Containing ICS	85 (43.8%)	116 (47.3%)	204 (47.7%)	364 (54.7%)	47 (61.0%)	16 (80%)	245 (68.1%)	85 (69.7%)	581 (55.2%)
Oral medication
Theophylline	115 (59.3%)	145 (59.2%)	256 (59.8%)	439 (65.9%)	42 (59.2%)	12 (60.0%)	275 (76.4%)	92 (75.4%)	688 (65.4%)
Aminophylline	12 (6.2%)	16 (6.5%)	21 (4.9%)	29 (4.4%)	5 (7.0%)	1 (5.0%)	9 (2.5%)	1 (0.8%)	47 (4.5%)
Steroids	9 (4.7%)	13 (5.3%)	30 (7.0%)	55 (8.3%)	11 (15.5%)	7 (35.0%)	53 (14.7%)	28 (23.0%)	103 (9.8%)
PDE-4 inhibitor	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)

Abbreviations: SABA, short acting beta-agonist; SAMA, short-acting muscarinic-antagonist; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist; LABD, long-acting bronchodilator; ICS, inhaled corticosteroid; PDE-4, phosphodiesterase-4.

Table 4 Concordance in pharmacological therapy between prescribed medications and GOLD 2011 or 2017 guidelines

COPD classifications	Group A		Group B		Group C		Group D		Total N=1,053
GOLD n (%)	2011 194 (18.4%)	2017 245 (23.3%)	2011 428 (40.6%)	2017 666 (63.2%)	2011 71 (6.7%)	2017 20 (1.9%)	2011 360 (34.2%)	2017 122 (11.6%)	2011	2017
Concordant	88 (45.4%)	102 (41.6%)	188 (43.9%)	251 (37.7%)	38 (53.5%)	11 (55.0%)	327 (90.8%)	109 (89.3%)	641 (60.9%)	473 (44.9%)
First choice	11 (5.7%)		159 (37.1%)		33 (46.5%)		134 (37.2%)		337 (32.0%)
Second choice	77 (39.7%)		29 (6.8%)		5 (7.0%)		193 (53.6%)		304 (28.9%)
Discordant	106 (54.6%)	143 (58.4%)	240 (56.1%)	415 (62.3%)	33 (46.5%)	9 (45.0%)	33 (9.2%)	13 (10.7%)	412 (39.1%)	580 (55.1%)
Undertreatment	21 (10.8%)	27 (11.0%)	39 (9.1%)	54 (8.1%)	8 (11.3%)	1 (5.0%)	33 (9.2%)	13 (10.7%)	101 (9.6%)	95 (9.0%)
Overtreatment	85 (43.8%)	116 (47.3%)	201 (47.0%)	361 (54.2%)	25 (35.2%)	8 (40.0%)	0 (0.0%)	0 (0.0%)	311 (29.5%)	485 (46.1%)

Figure 2 Changing of concordance in COPD patients in GOLD 2011 groups C and D according to GOLD 2011 and 2017 guidelines.