Which GOLD B patients progress to GOLD D with the new classification?

Area of Science:

• Pulmonology
• Respiratory Medicine
• Clinical Guidelines

Background:

• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) updated its guidelines in 2017, removing FEV1 as a sole criterion for COPD assessment.
• This shift necessitates understanding the impact on patient stratification and clinical outcomes.

Purpose of the Study:

• To analyze the redistribution of patients based on the 2011 GOLD criteria to the 2017 GOLD criteria.
• To characterize GOLD Group B patients and examine their natural disease progression under the 2017 guidelines.

Main Methods:

• Analysis of 2,010 COPD patients from the Korean COPD Subgroup Study cohort.
• Baseline and 1-year follow-up data were utilized to assess patient group changes and progression.

Main Results:

• A significant redistribution occurred: 2011 GOLD C patients moved to 2017 A (64.5%) and C (35.4%); 2011 GOLD D patients moved to 2017 B (61.6%) and D (38.6%).
• GOLD B patients comprised 62.7% of the cohort under the 2017 classification, showing better lung function and fewer symptoms than GOLD D patients.
• While 69.1% of GOLD B patients remained in their group, 13.8% progressed to GOLD D within a year, associated with older age, higher symptom burden (mMRC, SGRQ), and lower FEV1.

Conclusions:

• The 2017 GOLD criteria reclassify COPD patients, with a notable increase in GOLD Group B.
• Factors such as severe symptoms, poorer health status, and greater airflow limitation are linked to exacerbation risk and progression from GOLD B to D.