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Changes in the Burden of Comorbidities in Patients with COPD and Asthma-COPD Overlap According to the GOLD 2017
András Bikov1, Alpár Horváth2,3, Gábor Tomisa2,3
1Department of Pulmonology, Semmelweis University, 1/C, Diós árok, Budapest, 1125, Hungary. andras.bikov@gmail.com.
Insights
Recent GOLD guidelines reclassify many chronic obstructive pulmonary disease (COPD) patients. While this shift impacts comorbidity assessment, particularly osteoporosis in Asthma-COPD overlap (ACO), it minimally alters overall comorbidity profiles.
Area of Science:
- Pulmonary Medicine
- Internal Medicine
- Clinical Epidemiology
Background:
- Comorbidities significantly impact quality of life and mortality in chronic obstructive pulmonary disease (COPD).
- Asthma-COPD overlap (ACO) may present a distinct comorbidity profile compared to COPD alone.
- The effect of updated Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines on comorbidity profiles in COPD and ACO remains unclear.
Purpose of the Study:
- To investigate how recent changes in GOLD recommendations influence the comorbidity profile in patients with COPD and ACO.
- To compare comorbidity prevalence across different COPD severity groups defined by both 2016 and 2017 GOLD criteria.
Main Methods:
- Recruitment of 834 COPD patients from 67 Hungarian outpatient clinics, with 469 diagnosed with ACO.
- Comorbidity assessment by respiratory specialists using medical history, patient reports, and medication review.
- Classification of COPD severity using both 2016 and 2017 GOLD documents and comparison of comorbidity prevalence across ABCD groups.
Main Results:
- A substantial proportion of patients were reclassified under the 2017 GOLD criteria (66-72% from C/D to A/B).
- Osteoporosis prevalence differed among GOLD 2017 groups for all COPD patients (p=0.01) and was notable in ACO under GOLD 2016 (p=0.01).
- Cardiac arrhythmia showed inter-group differences in non-ACO COPD patients under GOLD 2017 (p<0.01); other common comorbidities remained unchanged.
Conclusions:
- The updated 2017 GOLD criteria lead to significant patient reclassification.
- These guideline changes have a minor impact on the overall comorbidity profile in COPD and ACO.
- Clinical practice should consider these shifts when assessing patients and their comorbidities.
Purpose:
Comorbidities associated with chronic obstructive pulmonary disease (COPD) affect quality of life and increase mortality. Asthma-COPD overlap (ACO) may express a different profile of comorbidities compared to COPD alone. It is unclear how recent changes in GOLD recommendations affect the profile of comorbidities in COPD and ACO.
Methods:
Eight hundred and thirty-four patients with COPD were recruited from 67 Hungarian secondary care outpatient clinics, 469 of them had ACO. Comorbidities were defined by respiratory specialists based on medical history, patient report, and medications. COPD grades were defined according to the old 2016 and the new 2017 GOLD document. Comorbidities were compared along COPD ABCD groups determined by the old and new GOLD.
Results:
66 and 72% of the COPD patients in groups C and D (GOLD 2016) were recategorized to groups A and B (GOLD 2017), respectively. There was no difference in the prevalence of disorders along the 2016 GOLD categories except for osteoporosis in ACO (p = 0.01). When the patients were categorized according to the 2017 GOLD criteria, the prevalence of osteoporosis (p = 0.01) was different among the four groups in all COPD patients. Subgroup analysis of non-ACO COPD patients revealed inter-group differences for cardiac arrhythmia (p < 0.01). No alteration was seen in the prevalence of coronary artery disease, hypertension, diabetes, or the total number of comorbidities.
Conclusion:
A significant number of patients are recategorized according to the GOLD 2017 criteria. This change only marginally affects the profile of comorbidities; still this needs to be considered when assessing the patients in daily practice.
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