The Relationship Between Clinical Phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stages/Groups in Patients With Chronic Obstructive Pulmonary Disease

Anuj Kumar Pandey; Ajay Kumar Verma; Arpita Singh; Surya Kant; Rakesh Kumar Dixit; Shyam Chand Chaudhary; Jyoti Bajpai; Ved Prakash; Umesh Pratap Verma

doi:10.7759/cureus.32116

The Relationship Between Clinical Phenotypes and Global Initiative for Chronic Obstructive Lung Disease (GOLD) Stages/Groups in Patients With Chronic Obstructive Pulmonary Disease

Cureus. 2022 Dec 1;14(12):e32116. doi: 10.7759/cureus.32116. eCollection 2022 Dec.

Authors

Anuj Kumar Pandey¹, Ajay Kumar Verma¹, Arpita Singh², Surya Kant¹, Rakesh Kumar Dixit³, Shyam Chand Chaudhary⁴, Jyoti Bajpai¹, Ved Prakash⁵, Umesh Pratap Verma⁶

Affiliations

¹ Respiratory Medicine, King George's Medical University, Lucknow, IND.
² Pharmacology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
³ Pharmacology and Therapeutics, King George's Medical University, Lucknow, IND.
⁴ Internal Medicine, King George's Medical University, Lucknow, IND.
⁵ Pulmonary and Critical Care Medicine, King George's Medical University, Lucknow, IND.
⁶ Periodontology, King George's Medical University, Lucknow, IND.

Abstract

Background Chronic obstructive pulmonary disease (COPD) cannot be properly characterised by a single metric, forced expiratory volume in the first second (FEV1), due to its complexity and heterogeneity. The GOLD 2017 report contained the ABCD evaluation method to measure airflow limitation, symptoms, and/or exacerbation risk. Objective The purpose of this study was to explore the relationship between clinical characteristics and GOLD groups or stages in patients with COPD. Methods This cross-sectional observational study was conducted at the department of respiratory medicine, King George's Medical University, Lucknow, Uttar Pradesh, India, between 2019 and 2022. Here, stable COPD patients' demographics, clinical characteristics, and the number of exacerbations were compared between the groups following the GOLD 2022 report. An unpaired t-test with Welch's correction, chi-square test, Fisher's exact test, one-way ANOVA, and Kruskal-Wallis test were used for statistical significance. Results In this study, 349 stable COPD patients (256 males and 93 females) were selected. The GOLD 2017 categorization placed 78 (22.4%) patients in group A, 158 (45.3%) in B, 44 (12.6%) in C, and 69 (19.8%) in D. Further, we used GOLD 2017 to classify COPD patients into 16 subgroups (1A-4D). FEV1 (% predicted) decreased across groups A to D (p<0.0001). Groups C and D had a longer duration of illness, higher COPD assessment test (CAT) score, higher Modified Medical Research Council (mMRC) dyspnea scale, longer exacerbation history, and more COPD hospitalizations in the previous year than groups A and B. More symptomatic patients (B and D) exhibited lower FEV1 (% predicted) and more severe airflow limitation than less symptomatic patients (A and C) (p=0.0002). Symptomatic individuals exhibited higher CAT and mMRC dyspnea scores (p<0.0001). Groups C and D comprised older patients and those with longer disease duration, higher mMRC dyspnea scale and CAT, lower FEV1, and more severe airflow limitation (A and B). Conclusion The present study demonstrates the distribution of COPD patients' clinical phenotypes in an Indian population. We conclude that the combined COPD assessment according to the GOLD 2022 guideline provides a better understanding of COPD.

Keywords: abcd assessment tool; airflow limitation; copd; copd assessment test; exacerbation; management; mmrc dyspnea scale; risks for hospitalization; spirometry; symptoms.