Cui Yanan, Dai Zhongshang, Luo Lijuan, Chen Ping, Chen Yan
Department of Respiratory Medicine, the Second Xiangya Hospital of Central South University, Changsha 410000, China.
J Thorac Dis. 2019 Apr;11(4):1303-1315. doi: 10.21037/jtd.2019.03.99.
In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) proposed new classification criteria for patients with chronic obstructive pulmonary disease (COPD), which categorizes them into groups A-D based on risk of exacerbations and symptoms. The impact of the 2017 revisions on categorization and subsequent drug selection has been insufficiently studied in China.
This observational, multicenter, cross-sectional study recruited patients attending the outpatient clinics of 12 tertiary hospitals in China between April 2016 and July 2018. Patients were classified according to the GOLD 2014 and 2017 classification criteria and profiled based on categorization, demographics, clinical characteristics, and treatment regimens.
In total, 1,278 COPD patients [mean age (±SD), 62.4±8.4 years; body mass index (BMI), 22.3±3.4 kg/m] were included. According to the GOLD 2014 and 2017 classification criteria, the distribution in groups A-D was 58 (4.5%), 288 (22.5%), 28 (2.2%), 904 (70.7%) and 71 (5.6%), 573 (44.8%), 15 (1.2%), 619 (48.4%), respectively. Overall, 32% of patients in groups C-D were reclassified to groups A-B. Based on both GOLD 2014 and 2017, low BMI and education level were independent risk factors for high risk of exacerbation (i.e., being in groups C-D) (P<0.05). The patients who were reclassified from group D to B were younger and had fewer symptoms than those who remained in group D. The most frequently prescribed regimen was triple inhaled treatment (39.4%). Inhaled corticosteroids (ICS) were prescribed across all groups, and 205 (71.9%) of the 285 patients who were reclassified from group D to B were treated with ICS.
GOLD 2017 reclassified COPD patients to low-risk groups. The risk of exacerbation increased with decreased BMI or education levels. Overtreatment was observed in many patients, and physicians should reexamine treatment patterns for patients reclassified into low-risk groups.
2017年，慢性阻塞性肺疾病全球倡议组织（GOLD）提出了慢性阻塞性肺疾病（COPD）患者的新分类标准，根据急性加重风险和症状将患者分为A - D组。2017年修订版对分类及后续药物选择的影响在中国尚未得到充分研究。
这项观察性、多中心、横断面研究纳入了2016年4月至2018年7月期间在中国12家三级医院门诊就诊的患者。根据GOLD 2014和2017分类标准对患者进行分类，并根据分类、人口统计学、临床特征和治疗方案进行分析。
共纳入1278例COPD患者[平均年龄（±标准差），62.4±8.4岁；体重指数（BMI），22.3±3.4kg/m²]。根据GOLD 2014和2017分类标准，A - D组的分布分别为58例（4.5%）、288例（22.5%）、28例（2.2%）、904例（70.7%）和71例（5.6%）、573例（44.8%）、15例（1.2%）、619例（48.4%）。总体而言，C - D组中32%的患者被重新分类为A - B组。基于GOLD 2014和2017标准，低BMI和低教育水平是急性加重高风险（即C - D组）的独立危险因素（P<0.05）。从D组重新分类到B组的患者比仍留在D组的患者更年轻，症状更少。最常用的治疗方案是三联吸入治疗（39.4%）。所有组均使用吸入性糖皮质激素（ICS），从D组重新分类到B组的285例患者中有205例（71.9%）接受了ICS治疗。
GOLD 2017将COPD患者重新分类为低风险组。急性加重风险随BMI或教育水平降低而增加。观察到许多患者存在过度治疗情况，医生应重新审视重新分类为低风险组患者的治疗模式。
