Bohadana Abraham, Wild Pascal, Rokach Ariel, Berg Assaf, Izbicki Gabriel
Department of Medicine, Shaare Zedek Medical Center and Faculty of Medicine, Respiratory Research Unit, Pulmonary Institute, Hebrew University of Jerusalem, 12, Bayit Street, 91031, Jerusalem, Israel.
PW Statistical Consulting, 54000, Laxou, France.
Lung. 2024 Nov 27;203(1):3. doi: 10.1007/s00408-024-00757-4.
In aging populations, the Global Initiative for Obstructive Lung Disease (GOLD) spirometry threshold may misclassify normal spirometry as airflow limitation. The Global Lung Initiative (GLI) method provides age-adjusted criteria. We investigated how the use of GOLD or GLI thresholds in an algorithm affects the classification of elderly smokers into COPD risk phenotypes.
Using a modified COPDGene algorithm, including exposure, symptoms, and abnormal spirometry, 200 smokers aged 60 years and older were classified into 4 mutually exclusive phenotypes: Phenotype A (no symptoms, normal spirometry; reference), Phenotype B (symptoms, normal spirometry; possible COPD), Phenotype C (no symptoms, abnormal spirometry; possible COPD), and Phenotype D (symptoms, abnormal spirometry; probable COPD). Abnormal spirometry was defined according to the GOLD or GLI criteria. A comparison was made between the GOLD- and GLI-defined phenotypes.
Using GLI criteria/cut-offs, 18.5% (n = 37) had phenotype A (no COPD), 42% (n = 84) had phenotype B (possible COPD), 7.5% (n = 15) had phenotype C (possible COPD), and 32% (n = 64) had phenotype D (probable COPD). Using GOLD criteria cut-offs, 14.5% (n-29) had phenotype A (no COPD); 31% (n = 62) had phenotype B, 11.5% (n = 23) had phenotype C (probable COPD), and 43% (n = 86) had phenotype D (probable COPD). Eight smokers with GOLD phenotype C were reclassified as GLI phenotype A, while 22 with GOLD phenotype D were reclassified as GLI phenotype B. Smokers identified as ‟probable COPD" by GOLD alone (potential false positives) had better spirometry results than those identified as ‟probable COPD" by both GOLD and GLI.
The use of the GOLD threshold in an algorithm resulted in older smokers being classified into more severe COPD risk phenotypes compared to the GLI threshold. This suggests that GOLD may misclassify smokers with less affected phenotypes as having respiratory impairment, potentially leading to unnecessary and harmful treatments.
在老龄化人群中，慢性阻塞性肺疾病全球倡议组织（GOLD）的肺活量测定阈值可能会将正常肺活量测定错误分类为气流受限。全球肺部倡议组织（GLI）的方法提供了年龄调整标准。我们研究了在一种算法中使用GOLD或GLI阈值如何影响老年吸烟者慢性阻塞性肺疾病（COPD）风险表型的分类。
使用一种改良的COPDGene算法，包括暴露因素、症状和异常肺活量测定，将200名60岁及以上的吸烟者分为4种相互排斥的表型：表型A（无症状，肺活量测定正常；参照）、表型B（有症状，肺活量测定正常；可能患有COPD）、表型C（无症状，肺活量测定异常；可能患有COPD）和表型D（有症状，肺活量测定异常；很可能患有COPD）。异常肺活量测定根据GOLD或GLI标准定义。对GOLD和GLI定义的表型进行比较。
使用GLI标准/临界值时，18.5%（n = 37）为表型A（无COPD），42%（n = 84）为表型B（可能患有COPD），7.5%（n = 15）为表型C（可能患有COPD），32%（n = 64）为表型D（很可能患有COPD）。使用GOLD标准临界值时，14.5%（n = 29）为表型A（无COPD）；31%（n = 62）为表型B，11.5%（n = 23）为表型C（很可能患有COPD），43%（n = 86）为表型D（很可能患有COPD）。8名GOLD表型C的吸烟者被重新分类为GLI表型A，而22名GOLD表型D的吸烟者被重新分类为GLI表型B。仅被GOLD判定为“很可能患有COPD”（潜在假阳性）的吸烟者的肺活量测定结果优于被GOLD和GLI均判定为“很可能患有COPD”的吸烟者。
与GLI阈值相比，在算法中使用GOLD阈值会使老年吸烟者被分类为更严重的COPD风险表型。这表明GOLD可能会将受影响较小表型的吸烟者错误分类为有呼吸功能损害，可能导致不必要且有害的治疗。
