TY - JOUR
T1 - Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification
T2 - a study of the general population
AU - Lange, Peter
AU - Marott, Jacob Louis
AU - Vestbo, Jørgen
AU - Olsen, Kim Rose
AU - Ingebrigtsen, Truls Sylvan
AU - Dahl, Morten
AU - Nordestgaard, Børge Grønne
PY - 2012/11/15
Y1 - 2012/11/15
N2 - 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 riskof exacerbations. Surprisingly, subgroupB, characterized bymoreseveredyspnea, hadsignificantlypoorer survival thangroupC, in spiteofa higher FEV1 level. This subgroupwarrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.
AB - 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 riskof exacerbations. Surprisingly, subgroupB, characterized bymoreseveredyspnea, hadsignificantlypoorer survival thangroupC, in spiteofa higher FEV1 level. This subgroupwarrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.
KW - Aged
KW - Female
KW - Forced Expiratory Volume
KW - Humans
KW - Male
KW - Prognosis
KW - Pulmonary Disease, Chronic Obstructive
KW - Spirometry
KW - Vital Capacity
U2 - 10.1164/rccm.201207-1299OC
DO - 10.1164/rccm.201207-1299OC
M3 - Journal article
C2 - 22997207
SN - 1073-449X
VL - 186
SP - 975
EP - 981
JO - American Journal of Respiratory and Critical Care Medicine
JF - American Journal of Respiratory and Critical Care Medicine
IS - 10
ER -
