Understanding the GOLD 2011 Strategy as applied to a real-world COPD population

• Published in: Respiratory medicine Vol. 108; no. 5; pp. 729 - 736
• Main Authors: Vestbo, Jørgen, Vogelmeier, Claus, Small, Mark, Higgins, Victoria
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2014; Elsevier Limited
• Subjects: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists - therapeutic use; Aged; Antibiotics; Bronchodilator Agents - therapeutic use; Bronchodilators; Chronic obstructive pulmonary disease; Classification; Comorbidities; Comorbidity; COPD; Cross-Sectional Studies; Demography; Diabetes; Disease Progression; Drug Utilization - statistics & numerical data; Exacerbations; Forced Expiratory Volume - physiology; Gastroesophageal reflux; Glucocorticoids - therapeutic use; GOLD document; Health Care Surveys; Health Insurance Portability & Accountability Act 1996-US; Humans; Inhaled corticosteroids; Middle Aged; Patients; Physicians; Professional Practice - statistics & numerical data; Pulmonary Disease, Chronic Obstructive - diagnosis; Pulmonary Disease, Chronic Obstructive - drug therapy; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary/Respiratory; Questionnaires; Severity of Illness Index; Sleep; Sleep apnea; Spirometry - methods; Variables; United Kingdom > UK; Denmark; Bronchodilators; GOLD document; Exacerbations; Inhaled corticosteroids; Comorbidities; COPD
• ISSN: 0954-6111; 1532-3064; 1532-3064
• DOI: 10.1016/j.rmed.2014.03.002

The aim of this analysis was to understand the implications of the GOLD 2011 multidimensional system for the assessment and management of COPD, using data from a real-world observational study. Data were drawn from the Adelphi Respiratory Disease Specific Programme, a cross-sectional survey of consulting patients in five European countries and in the US undertaken between June and September 2011. Patients were classified using both the GOLD 2010 and revised GOLD 2011 criteria, and profiled with regards to demographics, disease characteristics and treatment patterns. Information on 3813 COPD patients was collected. Disease characteristics showed a general tendency to worsen in parallel with worsening of symptoms. When comparing dual versus single risk criteria, the inclusion of exacerbation history resulted in an increase in the number of patients in high risk groups. The highest proportions of patients receiving inhaled corticosteroids (ICS) were in group D. However, a considerable proportion of patients in low risk groups were receiving ICS/long-acting β2 agonists. Our analysis confirmed the relationship between higher symptomatic burden, increased airflow limitation and exacerbation, and further illustrated the importance of including exacerbation history in the assessment of COPD to identify patients at high risk. As based on data from current clinical practice, this study also highlighted the frequent and potentially inappropriate use of ICS and bronchodilators in patients at low risk of experiencing exacerbations.