Source: International Congress 2014 – Longitudinal studies of respiratory disease
Disease area: Airway diseases

Abstract

Aims: We evaluated characteristics and outcomes of COPD patients classified as GOLD 2013 Grade C or D in a primary care database.Methods: A cohort of diagnosed COPD patients with MRC dyspnoea score and FEV1 % predicted recorded on the same day, and COPD exacerbation history collected the previous 12 months, was derived from the UK Clinical Practice Research Datalink (1/1/2004-31/12/2012). GOLD 2013 Grades C and D were further stratified based on qualification by airflow limitation only (C1/D1), exacerbation history only (C2/D2), or both (C3/D3). Future events (exacerbations/death/GOLD Grade change) were enumerated and incidence derived using person-time methods till censoring at death/leaving practice event or 31/12/2013.Results: In a cohort of 52,237 COPD patients, 21% qualified as C and 28% as D. Of these, the majority were further classified as C1 and D1 (Table1). During follow-up, patients in C2/D2 most frequently changed to lower risk GOLD grades (A/B). Future exacerbations were most frequent in the C3 and D3 subgroups; mortality was highest for the D3 group (Table 2).Conclusions: We identified important differences in COPD outcomes among pre-defined GOLD C/D subgroups among COPD patients managed in primary care.Sponsored by GSK RD.[table1

Table 2: Outcomes in GOLD 2013 Grades C/D

Gold 2013	Mortality Rate (%)	Moderate-Severe Exacerbations (rate/person-year)
C1	4	0.8
C2	3	1.5
C3	5	1.9
D1	8	1.1
D2	6	1.9
D3	10	2.4

Table 1: Baseline GOLD 2013 classification, N (%)

C	11058 (21)	D	14510 (28)
C1	- 5134 (46)	D1	- 6502 (45)
C2	- 4299 (38)	D2	- 3701 (26)
C3	- 1625 (15)	D3	- 4307 (30)
A	18104 (35)	B	8565 (16)

C1/D1 <50%FEV1pred, C2/D2 ³50%FEV1pred+³2moderate-severe/³1hospitalized exacerbation, C3/D3 <50%FEV1pred+³2mod-sev/³1hosp exac

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Citations should be made in the following way:
H. Müllerová, M. Han, R. Baxter, K. Davis (Uxbridge, United Kingdom; Ann Arbor, United States Of America). Characteristics and outcomes of GOLD C and D COPD patients. Eur Respir J 2014; 44: Suppl. 58, 2984

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