title: Prediction of the clinical course of chronic obstructive pulmonary disease, using the new GOLD classification: a study of the general population.
abstract: BACKGROUND
  The new Global Initiative for Obstructive Lung Disease (GOLD) stratification of chronic obstructive pulmonary disease (COPD) into categories A, B, C, and D is based on symptoms, level of lung function, and history of exacerbations.
  
  
  OBJECTIVE
  To investigate the abilities of this stratification to predict the clinical course of COPD.
  
  
  METHODS
  Two similar population studies were performed in an area of Copenhagen including 6,628 individuals with COPD.
  
  
  RESULTS
  The patients were monitored for an average period of 4.3 years regarding COPD exacerbations, hospital admissions, and mortality. The percentages of individuals experiencing a COPD exacerbation during the first year of observation were 2.2% in group A, 5.8% in group B, 25.1% in group C, and 28.6% in group D. One- and 3-year mortality rates were 0.6 and 3.8%, respectively, in group A, 3.0 and 10.6% in group B, 0.7 and 8.2% in group C, and 3.4 and 20.1% in group D. Groups B and D, characterized by a higher degree of dyspnea than groups A and C, had five to eight times higher mortality from cardiovascular disease and cancer than did groups A and C.
  
  
  CONCLUSIONS
  The new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, had significantly poorer survival than group C, in spite of a higher FEV(1) level. This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.
authors.affiliation: Section of Social Medicine, Department of Public Health, Copenhagen University, P.O. Box 2099, Øster Farimagsgade 5, DK-1014 Copenhagen K, Denmark. peter.lange@sund.ku.dk
authors.forename: Peter
authors.initials: P
authors.lastname: Lange
authors.forename: Jacob Louis
authors.initials: JL
authors.lastname: Marott
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
authors.forename: Kim Rose
authors.initials: KR
authors.lastname: Olsen
authors.forename: Truls Sylvan
authors.initials: TS
authors.lastname: Ingebrigtsen
authors.forename: Morten
authors.initials: M
authors.lastname: Dahl
authors.forename: Børge Grønne
authors.initials: BG
authors.lastname: Nordestgaard
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013147:Spirometry; D014797:Vital Capacity