Revised GOLD criteria under scrutiny

The recent reclassification of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria has been put through its paces by several researchers at this years ERS congress, with some authors concluding that the revised criteria will have an impact on treatment decisions.

Earlier this year the GOLD expert committee published its updated report on the diagnosis and management of COPD. Compared to previous versions the recommendations were simplified in order to highlight the importance of respiratory symptoms.

A key change was that spirometry was no longer included in the ABCD tool set to guide symptom burden and treatment.

During the session COPD management: new findings from large studies internist Wassim Labaki from Ann Arbour in Michigan presented an analysis of the COPD Gene cohort.

He told delegates that compared to 2011 GOLD criteria the 2017 criteria distributed more patients to group B and fewer to group D.

The difference in mortality rates between groups B and C were also more pronounced in the 2017 criteria.

GOLD 2011 also provided more accurate mortality discrimination than the 2017 criteria (2011 AUC:0.682 vs 2017 AUC 0.664 P<0.001).

However, the two classifications showed similar discrimination for exacerbations with increasing rates from A to D.

“The outcome differences between the classification criteria warrants testing in other longitudinal cohorts,” he told delegates.

Another study presented during the same session by Professor Roland Buhl from the Johannes Gutenberg University of Mainz looked at data from the TONADO and OTEMTO trials.

Applying the GOLD 2017 criteria to the data set resulted in a notable shift of patients to lower assessment categories.

Patients in the A and B group of the 2017 criteria had lower mean FEV1 and FEV1 % predicted than in the 2014 groups, because FEV1 no longer contributed to the ABCD classification.

“This shift of patients to a lower classification of disease severity has implications for treatment decisions, with the recommended therapy being LAMA and/or LABA for groups A and B,” he  said.

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