Am J Respir Crit Care Med. 2012 Sep 20. [Epub ahead of print]
Prediction of the Clinical Course of COPD using the new GOLD Classification: A Study of the General Population.
Source
Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Abstract
RATIONALE:
The new Global initiative for obstructive lung disease (GOLD) stratification of COPD into categories A, B, C and D is based on symptoms, level of lung function, and history of exacerbations.
OBJECTIVE:
To investigate the abilities of this stratification to predict clinical course of COPD.
METHODS:
Two similar population studies in the area of Copenhagen including 6,628 individuals with COPD.
MEASUREMENTS:
The patients were followed for an average period of 4.3 years with regard to COPD exacerbations, hospital admissions and mortality.
MAIN RESULTS:
The percentages of individuals experiencing a COPD exacerbation during the first year of observation was 2.2% in group A, 5.8% in group B, 25.1% in group C and 28.6% in group D. One- and 3-year mortality was 0.6% and 3.8%, respectively, in group A, 3.0% and 10.6% in group B, 0.7% and 8.2% in group C, and 3.4% and 20.1% in group D. The groups B and D, characterized by a higher degree of dyspnea than groups A and C, had a 5-8 times higher mortality from cardiovascular disease and cancer than the groups A and C.
CONCLUSIONS:
The new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, has a significantly poorer survival than group C, in spite of a higher level of forced expiratory volume in the first second of expiration (FEV1). This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.
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