Which GOLD B patients progress to GOLD D with the new classification?

BACKGROUND

The 2017 GOLD guidelines revised assessment of COPD by eliminating the FEV criterion.

AIM

First, we explored the redistribution of 2011 GOLD groups by reference to the 2017 GOLD criteria. Second, we investigated the characteristics of GOLD B patients and the natural course of GOLD B patients according to the 2017 GOLD guidelines.

METHODS

In total, 2,010 COPD patients in the Korean COPD Subgroup Study cohort were analyzed at baseline and 1 year after enrollment.

RESULTS

The 2011 GOLD C patients were redistributed to the 2017 A (64.5%) and C (35.4%) groups. The 2011 GOLD D patients were redistributed to the 2017 B (61.6%) and D (38.6%) groups. The GOLD B patients constituted 62.7% of all patients according to the 2017 classification. Such patients exhibited higher % predicted FEV values, longer six-minute walk distances, fewer symptoms, and lower inflammatory marker levels than GOLD D patients. Most GOLD B patients remained in that group (69.1%), but 13.8% progressed to group D at 1-year follow-up. The factors associated with progression from GOLD B to GOLD D were older age, higher modified Medical Research Council (mMRC) and St George's Respiratory Questionnaire (SGRQ) symptom scores, and a lower % predicted FEV value.

CONCLUSION

Severe symptoms, poorer health status, and greater airflow limitation increased patients' risk of exacerbation and progression from group B to group D when the 2017 GOLD criteria were applied.