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Am J Respir Crit Care Med. 2012 Nov 15;186(10):975-81. doi: 10.1164/rccm.201207-1299OC. Epub 2012 Sep 20.

Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population.

Author information

1
Section of Social Medicine, Department of Public Health, Copenhagen University, P.O. Box 2099, Ă˜ster Farimagsgade 5, DK-1014 Copenhagen K, Denmark. peter.lange@sund.ku.dk

Abstract

RATIONALE:

The new Global Initiative for Obstructive Lung Disease (GOLD) stratification of chronic obstructive pulmonary disease (COPD) into categories A, B, C, and D is based on symptoms, level of lung function, and history of exacerbations.

OBJECTIVES:

To investigate the abilities of this stratification to predict the clinical course of COPD.

METHODS:

Two similar population studies were performed in an area of Copenhagen including 6,628 individuals with COPD.

MEASUREMENTS AND MAIN RESULTS:

The patients were monitored for an average period of 4.3 years regarding COPD exacerbations, hospital admissions, and mortality. The percentages of individuals experiencing a COPD exacerbation during the first year of observation were 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 rates were 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. Groups B and D, characterized by a higher degree of dyspnea than groups A and C, had five to eight times higher mortality from cardiovascular disease and cancer than did 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, had significantly poorer survival than group C, in spite of a higher FEV(1) level. This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.

Comment in

PMID:
22997207
DOI:
10.1164/rccm.201207-1299OC
[Indexed for MEDLINE]

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