The effect of changes to GOLD severity stage on long term morbidity and mortality in COPD

Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV 1 ). This allows patients to change to less severe COPD sta...

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Veröffentlicht in:Respiratory research Jg. 19; H. 1; S. 249 - 10
Hauptverfasser: Flynn, Robert W. V., MacDonald, Thomas M., Chalmers, James D., Schembri, Stuart
Format: Journal Article
Sprache:Englisch
Veröffentlicht: London BioMed Central 12.12.2018
BioMed Central Ltd
Nature Publishing Group
BMC
Schlagworte:
Aged
Analysis
Chronic obstructive lung disease
Chronic obstructive pulmonary disease
Classification
Clinical trials
Cohort Studies
Dyspnea
Fatalities
Female
Follow-Up Studies
Forced Expiratory Volume - physiology
Global Health - trends
Global initiative for chronic obstructive lung disease (GOLD)
Gold
Health aspects
Humans
Longitudinal Studies
Lung diseases
Male
Medical research
Medicine
Medicine & Public Health
Middle Aged
Morbidity
Morbidity - trends
Mortality
Mortality - trends
Obstructive lung disease
Patients
Pneumology/Respiratory System
Pulmonary Disease, Chronic Obstructive - diagnosis
Pulmonary Disease, Chronic Obstructive - mortality
Pulmonary Disease, Chronic Obstructive - physiopathology
Respiration
Respiratory Function Tests - mortality
Respiratory Function Tests - trends
Scotland - epidemiology
Severity of Illness Index
Spirometry - mortality
Spirometry - trends
Studies
Time dependence
Scotland
Chronic obstructive pulmonary disease
Global initiative for chronic obstructive lung disease (GOLD)
Mortality
Morbidity
ISSN:1465-993X, 1465-9921, 1465-993X
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Zusammenfassung:Background The Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity stage classifies Chronic Obstructive Pulmonary Disease (COPD) into groups based on symptoms, exacerbations and forced expiratory volume in one second (FEV 1 ). This allows patients to change to less severe COPD stages, a novel aspect of assessment not previously evaluated. We aimed to investigate the association between temporal changes in GOLD severity stage and outcomes in COPD patients. Methods This was a record-linkage study using patients registered with a Scottish regional COPD network 2000–2015. Annual spirometry & symptoms were recorded and linked to healthcare records to identify exacerbations, hospitalisations and mortality. Spirometry, modified Medical Research Council (mMRC) dyspnoea scale and acute exacerbations over the previous year were used to assign GOLD severity at each visit. A time-dependent Cox model was used to model time to death. Secondary outcomes were respiratory specific mortality and hospitalisations. Effect sizes are expressed as Hazard Ratios HR (95%CI). Results Four thousand, eight hundred and eighty-five patients (mean age 67.3 years; 51.3% female) with 21,348 visits were included. During a median 6.6 years follow-up there were 1530 deaths. For the secondary outcomes there were 712 respiratory deaths and 1629 first hospitalisations. Across 16,463 visit-pairs, improvement in COPD severity was seen in 2308 (14%), no change in 11,010 (66.9%) and worsening in 3145 (19.1). Compared to patients staying in GOLD stage A, those worsening had a stepwise increased mortality and hospitalisations. Conclusions Improving COPD severity classification was associated with reduced mortality and worsening COPD severity was associated with increased mortality and hospitalisations. Change in GOLD group has potential as monitoring tool and outcome measure in clinical trials.
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ISSN:1465-993X
1465-9921
1465-993X
DOI:10.1186/s12931-018-0960-3