The revised GOLD 2017 COPD categorization in relation to comorbidities.

Area of Science:

• Pulmonology
• Internal Medicine
• Clinical Epidemiology

Background:

• The Global Initiative for Obstructive Lung Disease (GOLD) recently revised its COPD classification (A-D) based solely on symptoms and exacerbations.
• Previous assessments have not evaluated the association between this revised GOLD classification and the prevalence of major comorbidities in patients with Chronic Obstructive Pulmonary Disease (COPD).

Purpose of the Study:

• To investigate the relationship between the revised 2017 GOLD A-D groups and the presence of significant comorbidities in COPD patients.

Main Methods:

• Utilized baseline data from the COSYCONET COPD cohort, including 2228 patients.
• Identified comorbidities (e.g., hypertension, diabetes, heart failure) through patient self-reports and medication records.
• Categorized patients into GOLD groups A-D using the COPD Assessment Test (CAT) or modified Medical Research Council (mMRC) scale and GOLD exacerbation criteria.

Main Results:

• GOLD group D showed the strongest association with most comorbidities, followed by groups B and C, when compared to group A.
• All assessed comorbidities demonstrated a correlation with either symptoms or exacerbations (or both) when GOLD groups were dichotomized (AC vs. BD and AB vs. CD).
• These correlations held true regardless of whether the CAT or mMRC scale was used for categorization.

Conclusions:

• The current GOLD COPD classification possesses clinical significance beyond symptom and exacerbation assessment, as it correlates with the risk of major comorbidities.
• These findings underscore the critical need to identify and manage comorbidities in COPD patients, especially those with high symptom burden or frequent exacerbations who may not respond optimally to therapy.