title: Differences in outcomes between GOLD groups in patients with COPD in the TIOSPIR(®) trial.
abstract: BACKGROUND
  The aim of this study was to evaluate whether Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification could predict mortality risk factors and whether baseline treatment intensity would relate to mortality within each group, using data from TIOSPIR(®), the largest randomized clinical trial in COPD performed to date.
  
  
  METHODS
  A total of 17,135 patients from TIOSPIR(®) were pooled and grouped by GOLD grading (A-D) according to baseline Medical Research Council breathlessness score, exacerbation history, and spirometry. All-cause mortality and adjudicated cardiovascular (CV) and respiratory mortality were assessed.
  
  
  RESULTS
  Of the 16,326 patients classified, 1,248 died on treatment. Group B patients received proportionally more CV treatment at baseline. CV mortality risk, but not all-cause mortality risk, was significantly higher in Group B than Group C patients (CV mortality - hazard ratio [HR] =1.74, P=0.004; all-cause mortality - HR =1.18, P=0.11). Group D patients had a higher incidence of all-cause mortality than Group B patients (10.9% vs 6.6%). Similar trends were observed regardless of respiratory or CV medication at baseline. In contrast, respiratory deaths increased consistently from Groups A-D (0.3%, 0.8%, 1.6%, and 4.2% of patients, respectively).
  
  
  CONCLUSIONS
  The data obtained from the TIOSPIR(®) trial, supporting earlier studies, suggest that proportionally more CV medication and CV deaths occur in GOLD Group B COPD patients, although deaths attributed to respiratory causes are more prevalent in Groups C and D.
authors: Service de Pneumologie, Hôpital Cochin, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors: Daniel
authors: D
authors: Dusser
authors: Asthma and Allergy Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Robert A
authors: RA
authors: Wise
authors: Allergy Centre, Odense University Hospital, Odense C, Denmark, TX, USA.
authors: Ronald
authors: R
authors: Dahl
authors: Pulmonary/Critical Care, University of Texas, San Antonio TX, USA; South Texas Veterans Health Care System, San Antonio, TX, USA.
authors: Antonio
authors: A
authors: Anzueto
authors: Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA.
authors: Kerstine
authors: K
authors: Carter
authors: Boehringer Ingelheim Pharma Ltd, Bracknell, UK.
authors: Andy
authors: A
authors: Fowler
authors: Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
authors: Peter M
authors: PM
authors: Calverley
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality; D015897:Comorbidity; D018450:Disease Progression; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D019141:Respiratory System Agents / Q000627:therapeutic use*; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry / Q000379:methods / Q000706:statistics & numerical data; D000067251:Symptom Flare Up
chemical_list: D002317:Cardiovascular Agents; D019141:Respiratory System Agents
keywords: GOLD; TIOSPIR®; cardiovascular comorbidity; cardiovascular death; mortality; respiratory death