Exploring the Validity of GOLD 2023 Guidelines: Should GOLD C and D Be Combined?

Area of Science:

• Pulmonary Medicine
• Digital Health
• Clinical Guidelines

Background:

• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 guidelines revised COPD stratification, merging GOLD C and D into a new category E based solely on exacerbation history.
• This change omits symptomology (e.g., COPD Assessment Test scores) in differentiating high-risk patient groups.

Purpose of the Study:

• To evaluate the impact of the GOLD 2023 guideline changes by assessing disease progression in individuals stratified using the GOLD 2022 ABCD scheme.
• To determine if symptom severity and exacerbation rates remain distinct between GOLD C and D groups after the proposed guideline changes.

Main Methods:

• Utilized data from 1529 users of the myCOPD mobile application, a validated tool for COPD management in the UK.
• Quantified symptom severity using COPD Assessment Test (CAT) scores and exacerbation rates over a 12-month period for patients initially classified into GOLD B, C, and D groups.

Main Results:

• Significant differences in CAT scores persisted between GOLD C and D users after 12 months (P = 8.2 × 10^-23).
• GOLD C users exhibited significantly lower exacerbation rates than GOLD D users over the 12-month period (P = 3.1 × 10^-2).
• GOLD B users showed higher CAT scores and exacerbation rates compared to GOLD C users in the subsequent 12 months.

Conclusions:

• COPD Assessment Test (CAT) scores remain crucial for stratifying disease progression, reflecting both symptomology and future exacerbation risk.
• The proposed merger of GOLD C and D categories in the GOLD 2023 guidelines warrants reconsideration due to persistent significant differences in disease progression markers.