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Vol. 55. Issue 8.
Pages 414-420 (August 2019)
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Vol. 55. Issue 8.
Pages 414-420 (August 2019)
Original Article
DOI: 10.1016/j.arbr.2019.02.014
Acute Exacerbation According to GOLD 2017 Categories in Patients with Chronic Obstructive Pulmonary Disease
Exacerbación aguda en pacientes con enfermedad pulmonar obstructiva crónica según las categorías GOLD 2017
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Joohae Kima, Chang-Hoon Leeb,
Corresponding author
kauri670@empal.com

Corresponding author.
, Myung-Goo Leec, Kyeong-Cheol Shind, Kwang Ha Yooe, Seong Yong Limf, Ju Ock Nag, Chul-Gyu Yoob,h, Ki Suck Jungi, Sang-Do Leej, KOLD, KOCOSS investigators
a Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
b Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
c Division of Pulmonary, Allergy & Critical Care Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
d Division of Pulmonology and Allergy, Regional Center for Respiratory Disease, Yeungnam University Medical Center, Daegu, Republic of Korea
e Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
f Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
g Department of Pulmonary Medicine, Soonchunhyang University Cheonan Hospital, Cheonan-si, Republic of Korea
h Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
i Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Republic of Korea
j Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tables (4)
Table 1. Baseline characteristics of participants.
Table 2. The risk of future exacerbation risk among groups according to different classification systems.
Table 3. Predicting ability for future exacerbation risk according to different classification systems.
Table 4. The risk of future exacerbation risk among groups categorized by previous exacerbation history, FEV1 and symptom.
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Additional material (1)
Abstract
Introduction

The association between GOLD categorizations and future exacerbations has not been fully investigated. This study elucidates whether the GOLD 2017 classification is associated with different future exacerbation risk in patients with chronic obstructive pulmonary disease (COPD) compared with the previous GOLD categorization. Another objective was to investigate the impacts of the symptoms and FEV1 on the predicted future exacerbation independently of previous exacerbation history.

Methods

We analyzed patients from three prospective COPD cohorts (SNUH, KOCOSS, and KOLD) and evaluated the risk of moderate to severe exacerbation among different models, including GOLD grade (FEV1), GOLD 2011, and GOLD 2017.

Results

In total, 611 COPD patients were included (36 from SNUH, 257 from KOCOSS, and 318 from KOLD). GOLD 2017 classification, excluding FEV1% for categorization criteria, showed no differences in future exacerbation risk compared with GOLD grade and GOLD 2011 based on c-statistics. Among those with no frequent exacerbation history and FEV1 ≥50%, the group with more symptoms was significantly associated with future exacerbations than the group with less symptoms. A lower FEV1 (FEV1 <50%) was not associated with a higher future exacerbation risk than a higher FEV1 (FEV1 ≥50%), regardless of prior exacerbation history and symptom group.

Conclusion

The GOLD 2017 classification was not different from GOLD grade and GOLD 2011 regarding the association with future exacerbation risk, and there were no significant differences in exacerbation risk according to FEV1%. This suggests that FEV1 might not be an important factor in future exacerbation risk. These results partly support the GOLD 2017 assessment tool.

Keywords:
Chronic obstructive pulmonary disease
Pulmonary function tests
Emphysema
Acute exacerbation
Resumen
Introducción

La asociación entre la categorización GOLD y la aparición de futuras exacerbaciones no se ha investigado a fondo. Este estudio analiza si la clasificación GOLD 2017 se asocia a un riesgo de padecer exacerbaciones futuras en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) diferente al asociado a categorizaciones GOLD previas. Otro de los objetivos fue investigar el impacto de los síntomas y del volumen espiratorio forzado en el primer segundo (FEV1) en la exacerbación futura, independientemente de la historia previa de exacerbaciones.

Métodos

Se analizaron prospectivamente 3 cohortes de pacientes con EPOC (SNUH, KOCOSS y KOLD) y se evaluó el riesgo de exacerbación moderada y grave entre los diferentes modelos, incluyendo el grado GOLD (FEV1), GOLD 2011 y GOLD 2017.

Resultados

Se incluyeron un total de 611 pacientes con EPOC (36 de SNUH, 257 de KOCOSS y 318 de KOLD). La clasificación GOLD 2017 (excluyendo el porcentaje de FEV1 para el criterio de categorización) no mostró diferencias en el riesgo de exacerbación futura en comparación con el grado GOLD y GOLD 2011 según el estadístico C. Entre los pacientes sin historia previa de exacerbaciones y FEV150%, aquellos con mayor número de síntomas presentaron una asociación significativamente mayor con la aparición de exacerbaciones futuras que el grupo con menor número de síntomas. Valores más bajos de FEV1 (FEV1<50%) no se asociaron con un mayor riesgo de exacerbación futura que valores más elevados de FEV1 (FEV150%), independientemente de la historia previa de exacerbación y de los síntomas.

Conclusión

La clasificación GOLD 2017 no resultó diferente al grado GOLD y a la clasificación GOLD 2011 respecto a la asociación con el riesgo de exacerbación futura. Tampoco se determinaron diferencias significativas en el riesgo de exacerbación de acuerdo con el porcentaje de FEV1. Esto sugiere que FEV1 podría no ser un factor importante para el riesgo de exacerbación futura. Estos resultados apoyan en parte el uso de la herramienta de evaluación GOLD 2017.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Test de función pulmonar
Enfisema
Exacerbación aguda

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