title: Characteristics and longitudinal progression of chronic obstructive pulmonary disease in GOLD B patients.
abstract: The characteristics and natural history of GOLD B COPD patients are not well described. The clinical characteristics and natural history of GOLD B patients over 1 year in a multicentre cohort of COPD patients in the COPDMAP study were assessed. We aimed to identify the subgroup of patients who progressed to GOLD D (unstable GOLD B patients) and identify characteristics associated with progression.
  
  
  
  Three hundred seventy COPD patients were assessed at baseline and 12 months thereafter. Demographics, lung function, health status, 6 min walk tests and levels of systemic inflammation were assessed. Students t tests and Mann Whitney-U tests were used.
  
  
  
  One hundred seven (28.9%) of patients were categorised as GOLD B at baseline. These GOLD B patients had similar FEV1 to GOLD A patients (66% predicted). More GOLD B patients were current smokers (p = 0.031), had chronic bronchitis (p = 0.0003) and cardiovascular comorbidities (p = 0.019) compared to GOLD A. At 12 months, 25.3% of GOLD B patients progressed to GOLD D. These patients who progressed (unstable patients) had worse health status and symptoms (SGRQ-C Total, 50.0 v 41.1, p = 0.019 and CAT, 21.0 v 14.0, p = 0.006) and lower FEV1(60% v 69% p = 0.014) at baseline compared to stable patients who remained in GOLD B.
  
  
  
  Unstable GOLD B patients who progressed to GOLD D had a higher level of symptoms at baseline. A high symptom burden may predict an increased likelihood of disease progression in GOLD B patients.
authors.affiliation: Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, University of Manchester, Manchester, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Lawrence
authors.affiliation: Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, University of Manchester, Manchester, UK. ukolsum@meu.org.uk.
authors.forename: Umme
authors.identifier: 0000-0003-3993-7848
authors.initials: U
authors.lastname: Kolsum
authors.affiliation: Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, University of Manchester, Manchester, UK.
authors.forename: Vandana
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Gavin
authors.initials: G
authors.lastname: Donaldson
authors.affiliation: Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Richa
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR Respiratory Biomedical Research, Leicester, UK.
authors.forename: Bethan
authors.initials: B
authors.lastname: Barker
authors.affiliation: Department of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR Respiratory Biomedical Research, Leicester, UK.
authors.forename: Leena
authors.initials: L
authors.lastname: George
authors.affiliation: Department of Genetics, University of Leicester, Leicester, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Webb
authors.affiliation: Department of Genetics, University of Leicester, Leicester, UK.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Brookes
authors.affiliation: Department of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR Respiratory Biomedical Research, Leicester, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brightling
authors.affiliation: Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK.
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Wedzicha
authors.affiliation: Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, Medicines Evaluation Unit, University Hospital of South Manchester Foundation Trust, University of Manchester, Manchester, UK.
authors.forename: Dave
authors.initials: D
authors.lastname: Singh
mesh_terms: D000368:Aged; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000145:classification* / Q000503:physiopathology*; D012720:Severity of Illness Index; D006113:United Kingdom
keywords: Classification; Disease Progression; Symptoms