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What is the impact of GOLD 2017 recommendations in primary care? – a descriptive study of patient classifications, treatment burden and costs

Alicia Gayle, Scott Dickinson, Kevin Morris, et al.
Int J Chron Obstruct Pulmon Dis 2018;13:3485–92.
doi: 10.2147/COPD.S173664

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification of chronic obstructive pulmonary disease (COPD) patients has undergone several changes over the past few years. In 2013, it was overhauled to focus on symptoms and exacerbation history, in addition to airflow limitation. The recent 2017 report went one step further and uses only symptom and exacerbation frequency to guide treatment.

This population-based study uses the Clinical Practice Research Datalink (CPRD) to examine whether a cohort of COPD patients could be classified into the new GOLD criteria based on their primary care records. It also evaluates the treatment cost implications of doing so.

A total of 19,268 patients were included. When GOLD 2017 grading was applied, there was a significant shift towards less severe grading compared to GOLD 2013. Under GOLD 2013, only 46% of patients were classified as GOLD A or B; with 2017 criteria, this increased to 86%. Most patients moved from group D to B (65%) and from C to A (74%).

Regarding treatment, 32% of all patients were prescribed triple therapy, including 22% of GOLD A and 43% of GOLD B patients. Total costs for all study patients under current therapy were estimated to be £8,614,020 per year. If the GOLD 2017 recommended treatments were applied, this could be reduced to £6,141,361 – a 29% decrease.

The findings of this study suggest that reviewing and reclassifying patients using medical records is possible in clinical practice. Revising therapy recommendations based on the new classification may reduce inappropriate prescribing of inhaled corticosteroids (ICS) and improve clinical outcomes.

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