Dua Ruchi, Kumari Ranjeeta, Yadav Vivek, Ranjan Mayur, Kumar Subodh, Mishra Mayank, Tripathi Suryakant
Department of Pulmonary Medicine, AIIMS, Rishikesh, Uttarakhand, India.
Department of Community and Family Medicine, AIIMS, Rishikesh, Uttarakhand, India.
Lung India. 2019 May-Jun;36(3):183-187. doi: 10.4103/lungindia.lungindia_163_18.
Classification of chronic obstructive pulmonary (COPD) disease has changed from being solely based on spirometric variables to combined assessment including symptom scores and history of exacerbations/ hospitalizations. There is both lack of awareness regarding change in its assessment as well as underutilization due to time constraints and seeming complexity. Moreover, treatment of COPD needs to be tailored according to the new combined assessment.
Current study was planned to look at current stratification of patients according to new revised combined assessment (Global Initiative for Chronic Obstructive Lung Disease GOLD 2017) in comparison to old(GOLD 2011) as well as its incorporation in clinical practice. Co-relation between revised combined assessment and spirometric staging was also assessed.
418 consecutive COPD patients were enrolled, their dyspnea scores in terms of modified medical research council scale (mMRC), preceding history of hospitalization/ exacerbation over preceding one year and spirometric variables were recorded. Their stratification according to old and new classification recorded. Their past treatment records were reviewed and combined assessment if done recorded.
Substantial shift of categories is seen from C and D respectively to stage A and B on applying the new classification compared to old i.e more severe to less severe. Secondly, revised combined assessment is still highly underutilized. Revised combined assessment has positive co-relation with spirometry and post bronchodilator forced expiratory volume in 1 second(FEV).
Management of substantial number of stable COPD patients may need to be stepped down in accordance with revised combined assessment. There is a need to disseminate information regarding change in COPD classification and stress on its incorporation in our day-to day clinical practice. Revised combined assessment has positive co-relation with spirometry, stressing its utility even in peripheral centers without spirometry facilities.
慢性阻塞性肺疾病（COPD）的分类已从单纯基于肺功能测定变量转变为包括症状评分和加重/住院史的综合评估。由于时间限制和表面上的复杂性，人们对其评估变化缺乏认识，且未充分利用。此外，COPD的治疗需要根据新的综合评估进行调整。
本研究旨在根据新修订的综合评估（慢性阻塞性肺疾病全球倡议组织GOLD 2017）与旧版（GOLD 2011）对患者进行当前分层，并评估其在临床实践中的应用情况。还评估了修订后的综合评估与肺功能测定分期之间的相关性。
纳入418例连续的COPD患者，记录其根据改良医学研究委员会量表（mMRC）得出的呼吸困难评分、前一年的住院/加重史以及肺功能测定变量。记录他们根据旧版和新版分类的分层情况。回顾他们过去的治疗记录，并记录是否进行了综合评估。
与旧版相比，应用新版分类时，类别分别从C和D大幅转变为A和B期，即从更严重转变为不太严重。其次，修订后的综合评估仍未得到充分利用。修订后的综合评估与肺功能测定以及支气管扩张剂后1秒用力呼气量（FEV）呈正相关。
根据修订后的综合评估，大量稳定期COPD患者的管理可能需要降级。有必要传播有关COPD分类变化的信息，并强调将其纳入日常临床实践。修订后的综合评估与肺功能测定呈正相关，强调了其在没有肺功能测定设备的基层中心的实用性。
