Pulmonary Department, Hospital Universitario Ntra, Sra, de La Candelaria, Santa Cruz de Tenerife, Tenerife, Spain.
Respir Res. 2014 Jan 13;15(1):3. doi: 10.1186/1465-9921-15-3.
Little is known about the longitudinal changes associated with using the 2013 update of the multidimensional GOLD strategy for chronic obstructive pulmonary disease (COPD).
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.
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.
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).
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.
对于使用 2013 年更新的多维 GOLD 策略治疗慢性阻塞性肺疾病（COPD）相关的纵向变化知之甚少。
确定新 GOLD 方案中 COPD 患者的分布，并评估与仅基于肺功能的先前 GOLD 分期相比，这一分级在一年中的变化情况。
我们分析了 CHAIN 研究的数据，这是一项多中心观察性西班牙 COPD 患者队列研究，每年对患者进行监测。根据新的 GOLD 方案定义了以下类别：FEV1%、mMRC 呼吸困难量表、COPD 评估测试（CAT）、临床 COPD 问卷（CCQ）和加重-住院情况。除 CCQ 数据外，所有变量均有一年随访信息。
在基线时，评估了 828 例稳定的 COPD 患者。基于 mMRC 呼吸困难量表与 CAT 得分，患者的分布如下：A 组为 38.2%与 27.2%，B 组为 17.6%与 28.3%，C 组为 15.8%与 12.9%，D 组为 28.4%与 31.6%。一年时可获得 526 例患者的信息：64.2%的患者仍在同一组，但 C 组和 D 组显示出不同程度的变化。按组进行的年度进展主要与 CAT 评分的一年变化（RR，1.138；95%CI：1.074-1.206）和 BODE 指数值的变化（RR，2.012；95%CI：1.487-2.722）相关。
在新的 GOLD 分级分类中，用于确定症状严重程度的工具类型会极大地改变分组。一年后类别发生变化与 CAT 和 BODE 指数的纵向变化有关。
