Clinical characteristics and outcomes in Japanese patients with COPD according to the 2017 GOLD classification: the Ishinomaki COPD Network Registry

Figures & data

Table 1 Overview of GOLD classification

	1	II	III	IV
GOLD 2007	FEV1 ≥80% predicted	50% ≤ FEV1 <80% predicted	30% ≤ FEV1 <50% predicted	FEV1 ≤30% predicted or FEV1 ≤50% predicted plus chronic respiratory failure
	A	B	C	D
GOLD 2011	mMRC 0–1 and CAT <10 GOLD 1 or 2 Exacerbation history 0–1	mMRC ≥2 or CAT ≥10 GOLD 1 or 2 Exacerbation history 0–1	mMRC 0–1 and CAT <10 GOLD 3 or 4 Exacerbation history ≥2	mMRC ≥2 or CAT ≥10 GOLD 3 or 4 Exacerbation history ≥2
GOLD 2013	mMRC 0–1 and CAT <10 GOLD 1 or 2 Exacerbation history 0 or 1 (not leading to hospital admission)	mMRC ≥2 or CAT ≥10 GOLD 1 or 2 Exacerbation history 0 or 1 (not leading to hospital admission)	mMRC 0–1 and CAT <10 GOLD 3 or 4 Exacerbation history ≥2 or ≥1 (leading to hospital admission)	mMRC ≥2 or CAT ≥10 GOLD 3 or 4 Exacerbation history ≥2 or ≥1 (leading to hospital admission)
GOLD 2017	mMRC 0–1 and CAT <10 Exacerbation history 0 or 1 (not leading to hospital admission)	mMRC ≥2 or CAT ≥10 Exacerbation history 0 or 1 (not leading to hospital admission)	mMRC 0–1 and CAT <10 Exacerbation history ≥2 or ≥1 (leading to hospital admission)	mMRC ≥2 or CAT ≥10 Exacerbation history ≥2 or≥1 (leading to hospital admission)

Note: The severity of airflow limitation since GOLD 2011 is classified as follows: GOLD 1, FEV₁ ≥80% predicted; GOLD 2, 50% ≤ FEV₁ <80% predicted; GOLD 3, 30% ≤ FEV₁ <50% predicted; and GOLD 4, FEV₁ <30% predicted.

Abbreviation: CAT, COPD Assessment Test.

Figure 1 Distribution of A, B, C, and D groups according to GOLD 2011, GOLD 2013, and GOLD 2017 in the study population.

Figure 2 Distribution of GOLD stages of airflow limitation in the study population.

Table 2 Characteristics of the study patients at baseline according to the ABCD classification (n=401)

	A (n=240)	B (n=122)	C (n=16)	D (n=23)	P-value
Age (years)	73.3±6.8	77.8±7.6	74.6±8.9	74.8±8.1	<0.001
Male sex	216 (90.0)	110 (90.2)	15 (93.8)	21 (91.3)	0.966
BMI	23.8±3.7	23.4±4.3	24.0±3.7	20.8±3.4	0.0024
Smoking history (pack-years)	54.8±29.0	54.4±34.9	51.7±28.1	57.1±29.4	0.953
FEV1 (L)	1.76±0.56	1.26±0.56	1.59±0.53	0.83±0.36	<0.001
%FEV1 (%)	68.5±17.9	55.6±23.0	61.6±13.8	35.4±15.8	<0.001
FVC (L)	3.28±0.78	2.80±2.20	3.20±0.91	2.46±0.55	<0.001
GOLD stage					<0.001
1	67 (27.9)	18 (14.7)	0 (0)	0 (0)
2	139 (57.9)	49 (40.2)	15 (93.8)	3 (13.0)
3	31 (12.9)	40 (32.8)	0 (0)	8 (34.8)
4	3 (1.3)	15 (12.3)	1 (6.2)	12 (52.2)
mMRC dyspnea scale score	0.5±0.5	2.0±0.9	0.5±0.5	2.4±0.8	<0.001
CAT score	3.7±2.6	11.5±6.5	3.3±2.4	11.7±6.9	<0.001
Regular medicationa					<0.001
LAMA	85 (35.4)	31 (25.4)	7 (43.8)	0
LABA	20 (8.3)	6 (2.7)	0	0
ICS	1 (0.4)	1 (0.8)	0	0
LAMA/LABA	44 (18.3)	23 (18.9)	4 (25.0)	9 (39.1)
ICS/LABA	14 (5.8)	4 (3.3)	0	0
ICS/LAMA	5 (2.1)	1 (0.8)	0	0
LAMA/LABA/ICS	57 (23.8)	54 (44.3)	5 (31.3)	14 (60.9)
None	14 (5.8)	2 (1.6)	0	0
Home oxygen therapy	4 (1.7)	28 (23.0)	0	12 (52.2)	<0.001
Exacerbation historyb	0.067	0.082	1.31	1.13	<0.001

Notes: The data are shown as mean ± SD or as number (percentage).

a Numbers of long-acting bronchodilators or inhaled corticosteroids.

b Frequency of exacerbations during the previous year at baseline (events per person per year).

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test; ICS, inhaled corticosteroid; LABA, long-acting beta-agonist; LAMA, long-acting muscarinic antagonist.

Table 3 Comparison of the clinical phenotype of less symptomatic patients (groups A and C) with that of more symptomatic patients (groups B and D)

	Less symptomatic group (n=256)	More symptomatic group (n=145)	P-value
Age (years)	73.3±6.9	77.3±7.7	<0.001
Male sex	231 (90.2)	131 (90.3)	0.972
BMI	23.8±3.7	23.0±4.2	0.0297
Smoking history (pack-years)	54.6±28.9	54.9±34.0	0.932
FEV1 (L)	1.75±0.56	1.19±0.56	<0.001
%FEV1 (%)	68.1±17.7	52.4±23.2	<0.001
FVC (L)	3.28±0.78	2.75±2.03	<0.001
mMRC dyspnea scale score	0.5±0.5	2.0±0.9	<0.001
CAT score	3.7±2.6	11.5±6.5	<0.001
Regular medicationa			<0.001
1	113 (44.1)	38 (26.2)
2	67 (26.2)	37 (25.3)
3	62 (24.2)	68 (46.9)
Home oxygen therapy	4 (1.6)	40 (27.6)	<0.001
Exacerbation historyb	0.14±0.17	0.25±0.23	0.0233

Notes: The data are shown as mean ± SD or as number (percentage).

a Numbers of long-acting bronchodilators and inhaled corticosteroids.

b Frequency of exacerbations during the previous year at baseline (events per person per year).

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test.

Table 4 Comparison of the clinical phenotype of patients at low risk (groups A and B) with that of patients at high risk (groups C and D)

	Low-risk group (n=356)	High-risk group (n=39)	P-value
Age (years)	74.8±7.4	74.7±8.3	0.942
Male sex	326 (91.6)	36 (92.3)	0.653
BMI	23.7±3.8	22.1±3.8	0.0168
Smoking history (pack-years)	54.7±31.0	54.8±28.7	0.973
FEV1 (L)	1.59±0.61	1.14±0.57	<0.001
%FEV1 (%)	64.2±20.7	46.1±19.8	<0.001
FVC (L)	3.28±0.78	2.75±2.03	<0.001
mMRC dyspnea scale score	1.0±1.0	1.6±1.2	<0.001
CAT score	6.3±5.7	8.3±6.9	0.0496
Regular medicationa			0.0049
1	144 (40.4)	7 (17.9)
2	91 (25.6)	13 (33.3)
3	111 (31.2)	19 (48.7)
Home oxygen therapy	32 (9.0)	12 (30.8)	<0.001
Exacerbation historyb	0.072±0.259	1.20±0.47	<0.001

Notes: The data are shown as mean ± SD or as number (percentage).

a Numbers of long-acting bronchodilators and inhaled corticosteroids.

b Frequency of exacerbations during the previous year at baseline (events per person per year).

Abbreviations: BMI, body mass index; CAT, COPD Assessment Test.

Table 5 ORs of all exacerbations, exacerbations leading to hospital admission, and all-cause mortality according to the ABCD classification

	A	B	C	D
Exacerbations	1	2.95 (1.60–5.45)	3.92 (1.47–10.4)	5.45 (2.59–11.5)
Exacerbations leading to hospital admission	1	8.19 (2.82–23.8)	7.34 (1.45–37.1)	17.9 (5.65–56.5)
All-cause mortality	1	3.85 (0.98–15.1)	0	3.41 (0.37–31.4)

Note: The data are shown as OR (95% CI).

Table 6 Comparison of exacerbations and mortality between low-risk patients (groups A and B) and high-risk patients (groups C and D)

	Low-risk group (n=357)	High-risk group (n=38)	P-value
Exacerbations	38 (10.6)	12 (31.6)	<0.001
Exacerbations leading to hospital admission	21 (5.9)	9 (23.7)	<0.001
All-cause mortality	9 (2.5)	1 (2.6)	0.987

Note: The data are shown as number (percentage).