Usefulness of GOLD classification of COPD severity (original) (raw)
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Global assessment of the COPD patient: Time to look beyond FEV1?
Respiratory Medicine, 2009
COPD is a diverse disease entity with multiple dimensions that uniquely define the patient's performance, morbidity and mortality. FEV 1 is both the traditional metric used to define the progression of COPD as well as the strongest spirometric predictor of mortality in COPD patients. However, besides pulmonary functional abnormalities, COPD is also associated with significant systemic effects. Therefore, the global assessment of an affected patient should include different aspects of the consequences of this disorder, beyond the ''gold-standard'' assessment of airflow limitation. Quantification of the patient's dyspnea, body composition as expressed by BMI, simple measures of exercise capacity such as the 6MWD, assessment of comorbidities and identification of characteristics related to different phenotypes are features that may lead to more optimal management of such patients.
Beyond FEV1 in COPD: A review of patient-reported outcomes and their measurement
2012
Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV 1). However, the evidence suggests that FEV 1 is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO) instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new instruments do not necessarily have better discriminative or evaluative properties than older instruments. The development of new PRO tools, however, is crucial, not only to ensure that key COPD concepts are being reliably measured but also that the relevant treatment effects are being captured in clinical trials. In turn, this will help us to understand better the patient's experience of the disease.
Diagnosis, assessment, and phenotyping of COPD: beyond FEV1
International Journal of Chronic Obstructive Pulmonary Disease, 2016
COPD is now widely recognized as a complex heterogeneous syndrome, having both pulmonary and extrapulmonary features. In clinical practice, the diagnosis of COPD is based on the presence of chronic airflow limitation, as assessed by post-bronchodilator spirometry. The severity of the airflow limitation, as measured by percent predicted FEV 1 , provides important information to the physician to enable optimization of management. However, in order to accurately assess the complexity of COPD, there need to be other measures made beyond FEV 1. At present, there is a lack of reliable and simple blood biomarkers to confirm and further assess the diagnosis of COPD. However, it is possible to identify patients who display different phenotypic characteristics of COPD that relate to clinically relevant outcomes. Currently, validated phenotypes of COPD include alpha-1 antitrypsin deficiency, and "frequent exacerbators". Recently, a definition and assessment of a new phenotype comprising patients with overlapping features of asthma and COPD has been suggested and is known as "asthma COPD overlap syndrome". Several other phenotypes have been proposed, but require validation against clinical outcomes. Defining phenotypes requires the assessment of multiple factors indicating disease severity, its impact, and its activity. Recognition and validation of COPD phenotypes has an important role to play in the selection of evidence-based targeted therapy in the future management of COPD, but regardless of the diagnostic terms, patients with COPD should be assessed and treated according to their individual treatable characteristics.
Annals of the American Thoracic Society, 2017
There is continuing debate about whether to define airflow obstruction by a postbronchodilator ratio of forced expiratory volume in 1 second and forced vital capacity below 0.70, or by ratio values falling below the age-dependent lower limit of normal derived from general population data. To determine whether using the lower limit of normal criterion affects the classification and outcomes of patients previously defined as having chronic obstructive pulmonary disease by the fixed forced expiratory volume in 1 second and forced vital capacity ratio. We applied the lower limit of normal definition to pooled data from the TIOtropium Safety and Performance In Respimat(®) study that used the fixed forced expiratory volume in 1 second and forced vital capacity ratio for the clinical diagnosis of chronic obstructive pulmonary disease. 17,072 patients were analyzed; of these, 1,807 (10.6%) patients had a ratio ≥ lower limit of normal. Patients with a ratio ≥ lower limit of normal had simila...
Factors That May Affect FEV1 Change Of COPD Patients In One-Year Period
2020
INTRODUCTION: One of the hallmarks of COPD is the rate of FEV1 decline. There are many factors that may affect pulmonary parameters in a COPD patient. It was aimed to investigate the factors affecting FEV1 changes. MATERIAL-METHODS: COPD outpatients who attended our pulmonology clinic were included. Spirometric values and inhaler device usage performance at that time and 12 months ago were compared. RESULTS: Mean FEV1 values of 204 COPD patients decreased from 1.56±0.51 lt (53.4%) to 1.51±0.50 lt (53.2%). There was a statistically significant relationship between FEV1 change (decline / not) and gender, active smoking, regular inhaler device usage, exacerbation, hospitalization history in last year, presence of comorbidities and inhaler device adherence. FEV1 decline had positive correlation with the number of exacerbations in last year (r=0.432, p<0.001), and negative correlation with inhaler device usage score (r=-0.512, p<0.001) . Multivariate regression analysis demonstrate...
Maximal voluntary ventilation should not be estimated from FEV1 in COPD patients and healthy
Physiotherapists, 2019
Purpose: To evaluate the concordance between the value of the actual maximum voluntary ventilation (MVV) and the estimated value by multiplying the forced expiratory volume in the first second (FEV 1) and a different value established in the literature. Methods: A retrospective study was conducted with healthy subjects and patients with stable chronic obstructive pulmonary disease (COPD). Five prediction formulas MVV were used for the comparison with the MVV values. Agreement between MVV measured and MVV obtained from five prediction equations were studied. FEV 1 values were used to estimate MVV. Correlation and agreement analysis of the values was performed in two groups using the Pearson test and the Bland-Altman method; these groups were one group with 207 healthy subjects and the second group with 83 patients diagnosed with COPD, respectively. Results: We recruited 207 healthy subjects (105 women, age 47 ± 17 years) and 83 COPD patients (age 66 ± 6 years; 29 GOLD II, 30 GOLD III, and 24 GOLD IV) for the study. All prediction equations presented a significant correlation with the MVV value (from 0.38 to 0.86, p < 0.05) except for the GOLD II subgroup, which had a poor agreement with measured MVV. In healthy subjects, the mean difference of the value of bias (and limits of agreement) varied between-3.9% (-32.8 to 24.9%), and 27% (-1.4 to 55.3%). In COPD patients, the mean difference of value of bias (and limits of agreement) varied between-4.4% (-49.4 to 40.6%), and 26.3% (-18.3 to 70.9%). The results were similar in the subgroup analysis.
Adequate Patient Characterization in COPD: Reasons to Go Beyond GOLD Classification
The Open Respiratory Medicine Journal, 2009
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.
Treatment response in COPD: does FEV1 say it all? A post hoc analysis of the CRYSTAL study
ERJ Open Research, 2019
The association between clinically relevant changes in patient-reported outcomes (PROs) and forced expiratory volume in 1 s (FEV1) in patients with chronic obstructive pulmonary disease (COPD) has rarely been investigated.Using CRYSTAL, a 12-week open-label study in symptomatic, nonfrequently exacerbating patients with moderate COPD, we assessed at baseline the correlations between several PROs (Baseline Dyspnoea Index, modified Medical Research Council dyspnoea scale, COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ)), and between FEV1 and PROs. Associations between clinically relevant responses in FEV1, CAT, CCQ and Transition Dyspnoea Index (TDI) at week 12 were also assessed.Using data from 4324 patients, a strong correlation was observed between CAT and CCQ (rs=0.793) at baseline, with moderate or weak correlations between other PROs, and no correlation between FEV1 and any PRO. At week 12, 2774 (64.2%) patients were responders regarding TDI, CAT or CCQ, with 583...
Pulmonary function testing in COPD: looking beyond the curtain of FEV1
npj Primary Care Respiratory Medicine, 2021
Chronic obstructive pulmonary disease (COPD) management remains challenging due to the high heterogeneity of clinical symptoms and the complex pathophysiological basis of the disease. Airflow limitation, diagnosed by spirometry, remains the cornerstone of the diagnosis. However, the calculation of the forced expiratory volume in the first second (FEV1) alone, has limitations in uncovering the underlying complexity of the disease. Incorporating additional pulmonary function tests (PFTs) in the everyday clinical evaluation of COPD patients, like resting volume, capacity and airway resistance measurements, diffusion capacity measurements, forced oscillation technique, field and cardiopulmonary exercise testing and muscle strength evaluation, may prove essential in tailoring medical management to meet the needs of such a heterogeneous patient population. We aimed to provide a comprehensive overview of the available PFTs, which can be incorporated into the primary care physician’s practi...