title: Characteristics of a COPD population categorised using the GOLD framework by health status and exacerbations.
abstract: GOLD proposed a COPD assessment framework focussed on symptoms measured by the COPD Assessment Test™ (CAT) or the mMRC and on exacerbation risk based on poor lung function (FEV1 <50%) or a history of ≥2 exacerbations in the previous year. This analysis examined the characteristics of COPD patients recruited from routine clinical settings and classified using the GOLD framework. 1041 European COPD patients (38.5% from primary care) from the Adelphi Respiratory Disease Specific Programme with information on CAT, mMRC, spirometry and exacerbation history in the previous year were analysed. Their mean age was 64.9 ± 9.9 years and mean FEV1 was 62.5 ± 17.8% predicted; 80% were in GOLD 2 spirometric grade or milder. CAT and mMRC cut points identified different groups of patients; using CAT, the composition was: Group A 9.3%, Group B 48.5%, Group C 0.7% and Group D 41.5%. 80% were classified as high risk based on exacerbation history and 25% of patients in a low risk category (GOLD A and B) had 1 exacerbation in the previous year. The incidence of diabetes, hypertension and hyperlipidaemia rose with worsening GOLD group (all p < 0.0001); diabetes GOLD A 4%, GOLD B 16%, GOLD D 29%; hypertension GOLD A 38%, GOLD B 55%, GOLD D 65%; hyperlipidaemia GOLD A 13%, GOLD B 30%, GOLD D 37%. In patients seen in routine clinical settings, 25% of GOLD low risk patients had one exacerbation per year and the incidence of cardio-vascular and metabolic diseases increases with worsening GOLD group.
authors.affiliation: Clinical Science, St George's, University of London, London, United Kingdom. Electronic address: pjones@sgul.ac.uk.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Respiratory Centre of Excellence, GSK, Uxbridge, United Kingdom. Electronic address: gilbert.a.nadeau@gsk.com.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Nadeau
authors.affiliation: Adelphi Real World, Adelphi Group, Macclesfield, United Kingdom. Electronic address: Mark.Small@adelphigroup.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Small
authors.affiliation: Respiratory Centre of Excellence, GSK, Uxbridge, United Kingdom. Electronic address: lukasz.p.adamek@gsk.com.
authors.forename: Lukasz
authors.initials: L
authors.lastname: Adamek
mesh_terms: D000368:Aged; D015897:Comorbidity; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005062:European Union; D005260:Female; D005541:Forced Expiratory Volume; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D013147:Spirometry; D006113:United Kingdom / Q000453:epidemiology
keywords: CAT; COPD; Exacerbations; GOLD