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Area of Science:

  • Pulmonary Medicine
  • Clinical Research
  • Respiratory Disease Management

Background:

  • The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines have evolved, with GOLD 2017 separating spirometry results from ABCD grouping.
  • Previous COPD staging (GOLD 2011) relied on a combined assessment of exacerbation history, symptom severity (mMRC), and spirometry.
  • Understanding the impact of the GOLD 2017 revisions on patient stratification is crucial for accurate COPD management.

Purpose of the Study:

  • To investigate the shifts in COPD patient groups following the implementation of the GOLD 2017 guidelines.
  • To evaluate the suitability of existing treatment protocols under the new GOLD 2017 COPD classification system.
  • To identify factors associated with changes in COPD group classification.

Main Methods:

  • Stratification of 578 COPD patients from Turkish outpatient clinics into GOLD 2011 and GOLD 2017 ABCD groups.
  • Assessment of exacerbation history, modified Medical Research Council (mMRC) dyspnea score, and spirometry (FEV1) for classification.
  • Evaluation of current treatment protocols for suitability according to both GOLD 2011 and GOLD 2017 criteria.

Main Results:

  • Patient distribution shifted from GOLD 2011 (A:28%, B:15%, C:15%, D:42%) to GOLD 2017 (A:36%, B:22%, C:7%, D:35%).
  • Significant transitions observed: 53.4% of patients moved from GOLD 2011 Group C to GOLD 2017 Group A, and 18.4% from Group D to Group B.
  • Treatment suitability decreased from 66.3% (GOLD 2011) to 60.9% (GOLD 2017), with triple therapy being the most common inappropriate protocol.

Conclusions:

  • The GOLD 2017 guidelines resulted in reclassification of COPD patients, with a notable shift of individuals from higher-risk to lower-risk categories.
  • A significant proportion of patients, particularly those reclassified into lower-risk groups, exhibited characteristics (exacerbations, mMRC, FEV1) associated with higher risk.
  • Despite guideline updates, overtreatment remains a concern in COPD management, necessitating careful protocol evaluation.