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Prediction of mortality in patients with chronic obstructive pulmonary disease with the new Global Initiative for Chronic Obstructive Lung Disease 2017 classification: a cohort study

Anne Gedebjerg, Szimonetta Komjáthiné Szépligeti, Laura-Maria Holm Wackerhausen, et al.
Lancet Respir Med 2018;6:204–12
doi: 10.1016/S2213-2600(18)30002-X

Since 2007, chronic obstructive pulmonary disease (COPD) has been classified according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification system, based on patients’ forced expiratory volume in 1 second (FEV1) thresholds compared with predicted normal values. To address the complexity of the disease, and improve understanding of its effect on patients, the 2011 GOLD revision presented an ABCD classification system, combining respiratory symptoms, risk of exacerbation, and airflow limitations as indicated by FEV1. While guiding treatment, the 2011 classification does not predict mortality of respiratory outcomes any better than the GOLD 2007 classification. GOLD 2017 further subdivided its main ABCD groups according to spirometric 1–4 staging. In this Danish cohort study of 33,765 patients with COPD, Gedebjerg and colleagues sought to evaluate the predictive ability of the new GOLD 2017 ABCD classification for all-cause and respiratory mortality compared to the GOLD systems of 2007 and 2011. The paper concluded that the GOLD 2017 classification based on ABCD groups did not predict all-cause and respiratory mortality better than the 2007 and 2011 GOLD classifications. However, when 16 subgroups (1A to 4D) were defined, the new classification predicted mortality more accurately than the previous systems. None of the GOLD classifications appeared to have sufficient discriminatory power to be used as a standalone tool for risk classification of mortality in patients with COPD.

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