Prognostic risk profiling in COPD using Global Initiative for Chronic Obstructive Lung Disease 2023 ABE and comorbidity assessment: evidence from a register-based COPD cohort.

BACKGROUND

While the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 ABE classification system guides initial chronic obstructive pulmonary disease (COPD) treatment, patient heterogeneity and comorbidities complicate management. We investigated how the GOLD 2023 ABE classification and aligned comorbidity profiles affect patient outcomes in real-world Asian populations with COPD.

METHODS

We conducted a register-based cohort study of 38 928 patients from multiple institutions across Taiwan (from April 2017 to December 2021). We classified patients by GOLD 2023 ABE categories. Data included demographics, Charlson comorbidity index (CCI)-defined comorbidities, treatment, symptoms, questionnaires, spirometry, and outcomes.

RESULTS

Among COPD patients, 89.2% were males, and the median age was 71 years. Groups A comprised 30.2%, group B 46.4%, and group E 23.5% of patients. Among these, 28.3% of group A patients used inhaled corticosteroid-containing inhalers. Group E had the highest rates of GOLD 4 airway obstruction (11.8%), CCI score ≥4 (15.6%), and five-year mortality rate (22.6%). Group E demonstrated the highest risk of all-cause mortality (hazard ratio (HR) = 1.727; 95% confidence interval (CI) = 1.605-1.858) and moderate-to-severe exacerbation (HR = 2.127; 95% CI = 1.942-2.330) vs. group A. Key comorbidities, acute myocardial infarction (HR = 1.257; 95% CI = 1.057-1.430), congestive heart failure (HR = 1.836; 95% CI = 1.707-1.909), and pulmonary disease (HR = 1.071; 95% CI = 1.011-1.129), were associated with higher mortality. Acute myocardial infarction (HR = 1.251; 95% CI = 1.031-1.444), congestive heart failure (HR = 1.193; 95% CI = 1.089-1.285), and pulmonary disease (HR = 1.491; 95% CI = 1.405-1.550) were also associated with higher exacerbations, with patterns varying across GOLD groups.

CONCLUSIONS

In this large registry-based cohort, group E patients demonstrated the highest mortality and exacerbation risks. Cardiovascular and pulmonary comorbidities increased adverse outcome risks across all GOLD categories. Systematic comorbidity screening should be integrated into routine COPD care. Findings support personalised treatment approaches based on GOLD classification and comorbidity profiles.