2017 Global Initiative for Chronic Obstructive Lung Disease reclassifies half of COPD subjects to lower risk group
Received 8 September 2017
Accepted for publication 7 November 2017
Published 3 January 2018 Volume 2018:13 Pages 165—173
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Charles Downs
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Marieann Högman,1 Johanna Sulku,2,3 Björn Ställberg,4,5 Christer Janson,1 Kristina Bröms,3,4 Hans Hedenström,6 Karin Lisspers,4,5 Andrei Malinovschi6
1Department of Medical Sciences, Respiratory, Allergy and Sleep Research, 2Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, 3Center for Research & Development, Uppsala University/Region Gävleborg, Gävle, 4Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, 5Center for Clinical Research, Uppsala University, County Council Dalarna, Falun, 6Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala, Sweden
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
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