title: Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort.
abstract: The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) into four groups (A to D). We explored the characteristics, stability and relationship to outcomes of these groups within the ECLIPSE study (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) (n = 2101). Main results showed that: 1) these groups differed in several clinical, functional, imaging and biological characteristics in addition to those used for their own definition; 2) A and D groups were relatively stable over time, whereas groups B and C showed more temporal variability; 3) the risk of exacerbation over 3 years increased progressively from A to D, whereas that of hospitalisation and mortality were lowest in A, highest in D and intermediate and similar in B and C, despite the former having milder airflow limitation. The prevalence of comorbidities and persistent systemic inflammation were highest in group B. The different longitudinal behaviour of group A versus B and C versus D (each pair with similar forced expiratory volume in1 s (FEV1) values supports the 2011 GOLD proposal of assessing COPD patients by more than FEV1 only. However the assumption that symptoms do not equate to risk appears to be naïve, as groups B and C carry equally poor clinical outcomes, though for different reasons.
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona and CIBER Enfermedades Respiratorias, FISIB, Mallorca, Spain.
authors.forename: Alvar
authors.initials: A
authors.lastname: Agusti
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Edwards
authors.forename: Bartolomé
authors.initials: B
authors.lastname: Celli
authors.forename: William
authors.initials: W
authors.lastname: Macnee
authors.forename: Peter M A
authors.initials: PM
authors.lastname: Calverley
authors.forename: Hana
authors.initials: H
authors.lastname: Müllerova
authors.forename: David A
authors.initials: DA
authors.lastname: Lomas
authors.forename: Emiel
authors.initials: E
authors.lastname: Wouters
authors.forename: Per
authors.initials: P
authors.lastname: Bakke
authors.forename: Steve
authors.initials: S
authors.lastname: Rennard
authors.forename: Courtney
authors.initials: C
authors.lastname: Crim
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Miller
authors.forename: Harvey O
authors.initials: HO
authors.lastname: Coxson
authors.forename: Julie C
authors.initials: JC
authors.lastname: Yates
authors.forename: Ruth
authors.initials: R
authors.lastname: Tal-Singer
authors.forename: Jørgen
authors.initials: J
authors.lastname: Vestbo
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000401:mortality / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000503:physiopathology; D013997:Time Factors; D014797:Vital Capacity
chemical_list: D010100:Oxygen