Rubinsztajn Renata, Przybyłowski Tadeusz, Maskey-Warzechowska Marta, Karwat Krzysztof, Chazan Ryszarda
Warszawski Uniwersytet Medyczny, Katedra i Klinika Chorób Wewngtrznych, Pneumonologii i Alergologii.
Pol Merkur Lekarski. 2013 Apr;34(202):192-5.
The GOLD 2011 recommendations for chronic obstructive pulmonary disease (COPD) introduce a new classification system to optimize treatment in individual patients. Except for FEV,, this classification incorporates breathlessness measurement using modified medical research council questionnaire (mMRC) or the COPD assessment Test (CAT) and the number of exacerbations. The aim of our study was to compare the GOLD 2010 and GOLD 2011 COPD.
The study group consisted of 143 patients. Based on the post-bronchodilator FEV, only, as recommended in the GOLD 2010 report, there were 24 patients in stage I, 57patients in II, 43 in Ill and 19 in IV, respectively. In all patients, the number of exacerbations per year was noted and dyspnea was assessed with the modified MRC scale. The patients were subsequently graded to group A,B,C,D as proposed in the combined COPD assessment in GOLD 2011.
Grading of 51 (35,7%) patients according to the GOLD 2011 criteria was difficult; there were 22 patients in GOLD stage I/II with > or =2 exacerbations per year and 29 patients in GOLD stage Ill/IV with < 2 exacerbations per year. They were grading to more risk group.
The new classification according to GOLD 2011 lets on optimizations of the treatment, in most cases of COPD patients but in clinical practice, there may be problems with the classification of the patients with severe airway obstruction without frequent exacerbations and especially those with mild/moderate airflow limitation and frequent exacerbations.
慢性阻塞性肺疾病（COPD）的《慢性阻塞性肺疾病全球倡议2011》建议引入一种新的分类系统，以优化个体患者的治疗。除第一秒用力呼气容积（FEV₁）外，该分类纳入了使用改良医学研究委员会问卷（mMRC）或慢性阻塞性肺疾病评估测试（CAT）进行的呼吸困难测量以及急性加重次数。我们研究的目的是比较《慢性阻塞性肺疾病全球倡议2010》和《慢性阻塞性肺疾病全球倡议2011》对慢性阻塞性肺疾病的分类。
研究组由143例患者组成。根据《慢性阻塞性肺疾病全球倡议2010》报告中的建议，仅依据支气管扩张剂后FEV₁，分别有24例患者处于I期，57例处于II期，43例处于III期，19例处于IV期。记录所有患者每年的急性加重次数，并使用改良的医学研究委员会量表评估呼吸困难情况。随后，按照《慢性阻塞性肺疾病全球倡议2011》中联合慢性阻塞性肺疾病评估的提议，将患者分为A、B、C、D组。
根据《慢性阻塞性肺疾病全球倡议2011》标准对51例（35.7%）患者进行分级存在困难；有22例《慢性阻塞性肺疾病全球倡议》I/II期患者每年急性加重≥2次，29例《慢性阻塞性肺疾病全球倡议》III/IV期患者每年急性加重<2次。他们被分级到更高风险组。
《慢性阻塞性肺疾病全球倡议2011》的新分类有助于优化大多数慢性阻塞性肺疾病患者的治疗，但在临床实践中，对于气道严重阻塞但急性加重不频繁的患者，尤其是气流受限为轻度/中度且急性加重频繁的患者，分类可能存在问题。
