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Temporal transitions in COPD severity stages within the GOLD 2017 classification system.

Joan B Soriano1, Michael Hahsler2, Cecilia Soriano3

  • 1Instituto de Investigación Hospital Universitario de la Princesa (IISP) Universidad Autónoma de Madrid, Madrid, Spain; Scientific and Methodological Consultant of SEPAR, Spain(1); Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.

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The GOLD 2017 COPD staging shows group stability over five years, but individual patients frequently change stages, especially in more severe categories. This highlights significant patient-level variability in chronic obstructive pulmonary disease progression.

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Area of Science:

  • Pulmonary Medicine
  • Clinical Epidemiology

Background:

  • The stability and individual transition frequencies within the GOLD 2017 COPD staging system remain largely unknown.
  • Longitudinal data on COPD patient movement between stages is crucial for understanding disease dynamics.

Purpose of the Study:

  • To evaluate the stability of the GOLD 2017 COPD staging system over five years.
  • To determine the frequency of individual transitions between COPD stages.

Main Methods:

  • Re-analysis of the CHAIN cohort (959 COPD participants) using GOLD 2017 criteria.
  • Aggregation of individual patient stage changes into Markov chains.
  • Evaluation of group stability using joinpoint regression over five years of follow-up.

Main Results:

  • Group proportions in GOLD 2017 stages (A, B, C, D) remained stable from year one to five.
  • Significant individual patient transitions between stages were observed, particularly in stages C and D.
  • Annual probabilities of remaining in stage C ranged from 16-31%, and in stage D from 23-43%.

Conclusions:

  • The GOLD 2017 COPD staging demonstrates apparent group stability.
  • Substantial year-to-year variability exists at the individual patient level, indicating dynamic changes in COPD severity.