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New GOLD classification: longitudinal data on group assignment
Authors:Ciro Casanova  Jose M Marin  Cristina Martinez-Gonzalez  Pilar de Lucas-Ramos  Isabel Mir-Viladrich  Borja Cosio  German Peces-Barba  Miryam Calle-Rubio  Ingrid Solanes-García  Ramón Agüero  Alfredo de Diego-Damia  Nuria Feu-Collado  Inmaculada Alfageme  Rosa Irigaray  Eva Balcells  Antonia Llunell  Juan Bautista Galdiz  Margarita Marín  Juan José Soler-Catalu?a  Jose Luis Lopez-Campos  Joan B Soriano  Juan P de-Torres
Abstract:

Rationale

Little is known about the longitudinal changes associated with using the 2013 update of the multidimensional GOLD strategy for chronic obstructive pulmonary disease (COPD).

Objective

To determine the COPD patient distribution of the new GOLD proposal and evaluate how this classification changes over one year compared with the previous GOLD staging based on spirometry only.

Methods

We analyzed data from the CHAIN study, a multicenter observational Spanish cohort of COPD patients who are monitored annually. Categories were defined according to the proposed GOLD: FEV1%, mMRC dyspnea, COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and exacerbations-hospitalizations. One-year follow-up information was available for all variables except CCQ data.

Results

At baseline, 828 stable COPD patients were evaluated. On the basis of mMRC dyspnea versus CAT, the patients were distributed as follows: 38.2% vs. 27.2% in group A, 17.6% vs. 28.3% in group B, 15.8% vs. 12.9% in group C, and 28.4% vs. 31.6% in group D. Information was available for 526 patients at one year: 64.2% of patients remained in the same group but groups C and D show different degrees of variability. The annual progression by group was mainly associated with one-year changes in CAT scores (RR, 1.138; 95%CI: 1.074-1.206) and BODE index values (RR, 2.012; 95%CI: 1.487-2.722).

Conclusions

In the new GOLD grading classification, the type of tool used to determine the level of symptoms can substantially alter the group assignment. A change in category after one year was associated with longitudinal changes in the CAT and BODE index.
Keywords:COPD  GOLD  Longitudinal
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