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Adequate Patient Characterization in COPD: Reasons to Go Beyond GOLD Classification.

Verhage TL, Heijdra YF, Molema J, Daudey L, Dekhuijzen PN, Vercoulen JH - Open Respir Med J (2009)

Bottom Line: Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment.No significant differences were found in nine other aspects of HS.It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate.

View Article: PubMed Central - PubMed

Affiliation: Departments of Pulmonary Diseases and Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

ABSTRACT
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) serves as a guide to treat and manage different severity classes of patients with COPD. It was suggested that the five categories of FEV(1) % predicted (GOLD 0-4), can be applied for selecting different therapeutic approaches. However, validation of these selective properties is very poor. To determine the relevance of the GOLD staging system for estimating the severity of clinical problems, GOLD 2 (n=70) and GOLD 3 (n=65) patients were drawn from a prospective cohort of patients with COPD and evaluated crosssectionally by a newly developed Nijmegen Integral Assessment Framework (NIAF). The NIAF is a detailed assessment of a wide range of aspects of health status (HS). Significant, though small, differences were found in Static Lung Volumes, Exercise Capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL, besides Airflow of course. Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment. No significant differences were found in nine other aspects of HS. It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate.

No MeSH data available.


Related in: MedlinePlus

Box plots of Sub-domainTotalScores (y-axis) which were significant in t-test, split by GOLD stage (x-axis).
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Figure 2: Box plots of Sub-domainTotalScores (y-axis) which were significant in t-test, split by GOLD stage (x-axis).

Mentions: Though a clear difference existed between GOLD 2 and 3 regarding the sub-domain Airflow, differences in the other Sub-domainTotalScores were small or absent. Statistical significant differences were only found in five out of the other 14 sub-domains: Static lung volumes, Exercise capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL. The sub-domain Gas Exchange (Table 2) lacks a Sub-domainTotalScore, as the two composing variables were not linear in distribution. Box-plots (Fig. 2) show that considerable overlap existed between GOLD stage 2 and 3 for all five sub-domains that reached statistical significance.


Adequate Patient Characterization in COPD: Reasons to Go Beyond GOLD Classification.

Verhage TL, Heijdra YF, Molema J, Daudey L, Dekhuijzen PN, Vercoulen JH - Open Respir Med J (2009)

Box plots of Sub-domainTotalScores (y-axis) which were significant in t-test, split by GOLD stage (x-axis).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2682926&req=5

Figure 2: Box plots of Sub-domainTotalScores (y-axis) which were significant in t-test, split by GOLD stage (x-axis).
Mentions: Though a clear difference existed between GOLD 2 and 3 regarding the sub-domain Airflow, differences in the other Sub-domainTotalScores were small or absent. Statistical significant differences were only found in five out of the other 14 sub-domains: Static lung volumes, Exercise capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL. The sub-domain Gas Exchange (Table 2) lacks a Sub-domainTotalScore, as the two composing variables were not linear in distribution. Box-plots (Fig. 2) show that considerable overlap existed between GOLD stage 2 and 3 for all five sub-domains that reached statistical significance.

Bottom Line: Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment.No significant differences were found in nine other aspects of HS.It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate.

View Article: PubMed Central - PubMed

Affiliation: Departments of Pulmonary Diseases and Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

ABSTRACT
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) serves as a guide to treat and manage different severity classes of patients with COPD. It was suggested that the five categories of FEV(1) % predicted (GOLD 0-4), can be applied for selecting different therapeutic approaches. However, validation of these selective properties is very poor. To determine the relevance of the GOLD staging system for estimating the severity of clinical problems, GOLD 2 (n=70) and GOLD 3 (n=65) patients were drawn from a prospective cohort of patients with COPD and evaluated crosssectionally by a newly developed Nijmegen Integral Assessment Framework (NIAF). The NIAF is a detailed assessment of a wide range of aspects of health status (HS). Significant, though small, differences were found in Static Lung Volumes, Exercise Capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL, besides Airflow of course. Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment. No significant differences were found in nine other aspects of HS. It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate.

No MeSH data available.


Related in: MedlinePlus