Chest

Chest

Volume 143, Issue 3, March 2013, Pages 694-702
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Original Research
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Distribution and Prognostic Validity of the New Global Initiative for Chronic Obstructive Lung Disease Grading Classification

https://doi.org/10.1378/chest.12-1053Get rights and content

Background

The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) update includes airflow limitation, history of COPD exacerbations, and symptoms to classify and grade COPD severity. We aimed to determine their distribution in 11 well-defined COPD cohorts and their prognostic validity up to 10 years to predict time to death.

Methods

Spirometry in all 11 cohorts was postbronchodilator. Survival analysis and C statistics were used to compare the two GOLD systems by varying time points.

Results

Of 3,633 patients, 1,064 (33.6%) were in new GOLD patient group A (low risk, less symptoms), 515 (16.3%) were B (low risk, more symptoms), 561 (17.7%) were C (high risk, less symptoms), and 1,023 (32.3%) were D (high risk, more symptoms). There was great heterogeneity of this distribution within the cohorts (χ2, P < .01). No differences were seen in the C statistics of old vs new GOLD grading to predict mortality at 1 year (0.635 vs 0.639, P = .53), at 3 years (0.637 vs 0.645, P = .21), or at 10 years (0.639 vs 0.642, P = .76).

Conclusions

The new GOLD grading produces an uneven split of the COPD population, one-third each in A and D patient groups, and its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only.

Section snippets

Materials and Methods

Our study design is of a pooled-analysis of individual patient data,5 from a number of COPD patient cohorts, all in Spain: Galdakao,6 Pamplona,7 Requena,8, 9 Sevilla,10 Tenerife,11 Terrassa,12, 13, 14 and Zaragoza.15 Comprehensive details of the Collaborative Cohorts to Assess Multicomponent Indices of COPD in Spain (COCOMICS) study are available elsewhere (J. M. Marin, MD; I. Alfageme, MD; P. Almagro, MD, et al, unpublished data). Briefly, a minimum data set with age, sex, spirometry, and

Results

We obtained data of 3,633 patients with COPD from 11 cohorts in Spain. They had an age (mean ± SD) of 66.4 ± 9.7 years, 93.3% were men, and 6.7% women. Women were younger (59.8 ± 11.0 years vs 66.9 ± 9.5 years) and more frequently current smokers (43.3% vs 26.8%) than men (both P < .05), but the size of the female group (n = 244) makes us reluctant to report results by sex. At study entry, smoking exposure was substantial (53.4 ± 26.5 pack-years), and 71.0% were former smokers while 27.9% were

Discussion

We report that the new GOLD grading produces an uneven split of the COPD population, one-third each in A and D patient groups, while one in six patients with COPD are B and C, respectively, which to our knowledge is a novel finding. Of interest, its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only. We believe the new GOLD grading makes more clinical sense, as decisions on treatment should not only be based (they never were) on

Conclusions

We conclude that the new GOLD grading produces an uneven split of the COPD population, one-third each in A and D patient groups. Its prognostic validity to predict time to death is no different from the old GOLD staging based in spirometry only.

Acknowledgments

Author contributions: Dr Soriano is the guarantor of the manuscript and takes responsibility for its data.

Dr Soriano: contributed to and approved the manuscript, conceived the original idea for the manuscript, developed the plan of analysis, and drafted the report.

Dr Alfageme: contributed to and approved the manuscript and collected clinical data.

Dr Almagro: contributed to and approved the manuscript and collected clinical data.

Dr Casanova: contributed to and approved the manuscript and

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    • Funding/Support: The authors have reported to CHEST that no funding was received for this study.

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