Clinical characteristics of patients with chronic obstructive pulmonary disease assessed using GOLD 2016 and GOLD 2018 classifications: a cross-sectional study in China

Wenhua Jian; Huiqing Zeng; Xiaoju Zhang; Chunmei Yun; Zuojun Xu; Yan Chen; Guochao Shi; Yingyu Wang; Yun Li; Jinping Zheng

doi:10.21037/jtd-21-255

Clinical characteristics of patients with chronic obstructive pulmonary disease assessed using GOLD 2016 and GOLD 2018 classifications: a cross-sectional study in China

J Thorac Dis. 2021 Oct;13(10):5701-5716. doi: 10.21037/jtd-21-255.

Authors

Wenhua Jian¹, Huiqing Zeng², Xiaoju Zhang³, Chunmei Yun⁴, Zuojun Xu⁵, Yan Chen⁶, Guochao Shi⁷, Yingyu Wang⁸, Yun Li⁸, Jinping Zheng¹

Affiliations

¹ State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
² Department of Respiratory Medicine, Zhongshan Hospital Xiamen University, Xiamen, China.
³ Department of Pulmonary and Critical Care Medicine, Henan Provincial People's Hospital, Zhengzhou, China.
⁴ Department of Pulmonary and Critical Care Medicine, Inner Mongolia Autonomous Region People's Hospital, Hohhot, China.
⁵ Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
⁶ Department of Respiratory and Critical Medicine, The Second Xiangya Hospital, Central South University, Changsha, China.
⁷ Department of Pulmonary and Critical Care Medicine, Shanghai Rui Jin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
⁸ GlaxoSmithKline, Shanghai, China.

Abstract

Background: In 2017, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) removed spirometry as a criterion for classifying GOLD risk groups (A-D, low-high risk).

Methods: In this cross-sectional observational study in China, we used the GOLD 2016 (spirometry included) and 2018 (spirometry eliminated) criteria for classifying GOLD risk groups to describe: the proportion of patients with chronic obstructive pulmonary disease (COPD) in each GOLD risk group; disease severity; demographics and comorbidities. Patients aged ≥40 years with a clinical COPD diagnosis for ≥1 year were included. During a single study visit, patients completed the COPD assessment test, modified Medical Research Council (mMRC) dyspnea scale assessment, and spirometry tests. Demographics, medical history, and treatment data were recorded.

Results: In total, 838 patients were included. Most patients were male (86.4%), ≥65 years old (58.6%), and current or former smokers (78.5%). By GOLD 2016, the highest proportion of patients were Group D (42.8%), followed by B (28.2%). By GOLD 2018, the highest proportion of patients were Group B (57.3%), followed by A (25.5%). A total of 296 patients (35.3%) were reclassified, either from Group C to Group A or from Group D to Group B. Overall, 36.2% of patients were receiving treatment concordant with GOLD 2016 recommendations; 34.1% were not receiving any inhaled medication.

Conclusions: The distribution of COPD severity shifted from a high-risk category (by GOLD 2016) to a low-risk category (by GOLD 2018). The high proportion of patients not receiving maintenance medication reflects a high level of under-treatment of the disease.

Keywords: China; Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification; chronic obstructive pulmonary disease (COPD); cross-sectional observational study; dyspnea-scale assessment.