2011 GOLD Stages of COPD: Transitions, Predictor Factors and Comparison with 2017 GOLD Stages
Received 26 March 2020
Accepted for publication 12 June 2020
Published 30 June 2020 Volume 2020:15 Pages 1519—1527
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Richard Russell
Roberto Bernabeu-Mora,1– 3 M Piedad Sánchez-Martínez,3,4 Joaquina Montilla-Herrador,3,4 Silvana L Oliveira-Sousa,3,4 Mariano Gacto-Sánchez,5 Francesc Medina-Mirapeix3,4
1Division of Pneumology, Hospital General Universitario Morales Meseguer, Murcia, Spain; 2Department of Internal Medicine, University of Murcia, Murcia, Spain; 3Research Group Fisioterapia y Discapacidad, Instituto Murciano de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB-Arrixaca), El Palmar, Murcia, Spain; 4Department of Physical Therapy, University of Murcia, Murcia, Spain; 5Department of Physical Therapy, EUSES University School, University of Girona, Girona, Spain
Correspondence: Joaquina Montilla-Herrador
Department of Physical Therapy, University of Murcia, Campus de Espinardo, Murcia 30100, Spain
Background: Despite wide use of the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) 2011, little is known about between-stage transitions and what factors predict worsening transitions in patients with chronic obstructive pulmonary disease (COPD).
Objective: To investigate the transition frequency between GOLD 2011 stages among patients with stable COPD over a 2-year follow-up, to identify potential non-pulmonary predictor factors for worsening transitions, and to compare transition frequencies between GOLD 2011 stages and the new GOLD 2017 stages.
Patients and Methods: We prospectively included 137 patients with stable COPD (mean age, 66.9 ± 8.3 years). GOLD 2011 and GOLD 2017 stages were measured at baseline, 1-year follow-up, and 2-year follow-up. To evaluate non-pulmonary variables as potential predictors of worsening transitions, we used regression models adjusted for sociodemographic, clinical, and pulmonary variables using generalized estimating equations.
Results: The study period included 246 opportunities for transition, and 39 worsening transitions occurred within GOLD 2011 stages. Predictors of worsening transitions included BODE index (OR, 1.20; 95% CI, 1.00– 1.44), quadriceps strength (OR, 0.87; 95% CI, 0.76– 0.99), and limited mobility activities (OR, 1.02; 95% CI, 1.00– 1.05). The frequency of worsening transitions for stages B and C differed between GOLD 2011 and GOLD 2017. Stages A and D were the most stable in both classifications.
Conclusion: Non-pulmonary factors predicted worsening transitions among the GOLD 2011 stages of COPD severity. The choice of GOLD 2011 versus GOLD 2017 may influence transition identification, especially for stages B and C.
Keywords: GOLD, quadriceps strength, BODE, mobility activities, COPD exacerbations
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