Stratification of patients with COPD according to the 2011 GOLD report

The authors aimed to compare the distribution of COPD based on the new GOLD grading with stadium based exclusively on spirometry.

Eligible patients had an average age of 64.8 years and smoked at least 10 pack-years. COPD was defined according to GOLD fixed cut-off criterion FEV1/FVC < 0.70. In all patients postbronchodilator spirometry was performed. Categories were defined with the mMRC dyspnoea scale and CAT scale. COPD exacerbations in the previous year and lung function were evaluated. Statistical comparisons were done using t-student test.

315 COPD patients, 99 (31.4%) women and 216 (68.6%) men, were examined. Mean pack-years in the whole group was 47.1 ± 17.8. In women this figure was less than in men, 43.7 ± 19.2 vs 49.5 ± 16.5 (p > 0.05), respectively. At study entry, 144 subjects (45.7%) were current smokers, and the majority of them (n-87, 60.4%) belonged to category D - 26/66 (54.5%) women and 51/102 (50%) men. Based on spirometry alone, the patients were classified as moderate COPD 144 (45.71%), severe - 154 (48.89%), and very severe 17 (5.4%). According to the 2011 GOLD report stratification, 60 patients (19.04%) were graded as category A, 63 (20%) as category B, 24 (7.62%) as category C, and 168 (53.33%) as category D, although 21 (12.5% of them) were in category B, but the number of exacerbations classified them as category D.

The COPD population is heterogeneous in reference to the symptoms, value of FEV1, and susceptibility to exacerbations. Clinical symptoms assessed using validated questionnaires characterized COPD patients better than the value of spirometric parameters (which are necessary for diagnosis of this disease). Some patients were difficult to classify, especially those belonging to category C.