PT  - JOURNAL ARTICLE
AU  - Daiana Stolz
AU  - Kostantinos Kostikas
AU  - Francesco Blasi
AU  - Branislava Milenkovic
AU  - Wim Boersma
AU  - Joachim Aerts
AU  - Renaud Louis
AU  - Tobias Welte
AU  - Alicia Lacoma
AU  - Cristina Prat
AU  - Andreas Scherr
AU  - Janko Rakic
AU  - Marilena Pappalettera
AU  - Gernot Rohde
AU  - Antoni Torres
AU  - Sabine Hertel
AU  - Sven Giersdorf
AU  - Michael Tamm
TI  - Combined assessment according to the new GOLD guidelines and its relation to outcome in COPD
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - 1648
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/1648.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/1648.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - BACKGROUND: The new GOLD guidelines recommend pharmacological and non-pharmacological management of COPD to be individualized based on the assessment of symptoms and exacerbation risk (A=low risk, less symptoms, B=low risk, more symptoms, C=high risk, less symptoms, D=high risk, more symptoms). We hypothesize that functional parameters and the risk of future events differ among patients categorized by the combined assessment according to the guidelines.METHODS:We prospectively evaluated 638 patients with stable COPD for ≥ 6 weeks, > 10 PY and GOLD II-IV seeking care in pulmonary tertiary hospitals in 8 European countries and included in the PROMISE cohort. The outcome variables were exacerbation and death from any cause. Median observation time was 24 months.RESULTS:There were 1152 exacerbations, 225 severe exacerbations and 63 deaths among 586 patients classified as A=50 (7.8%), B =184 (28.8%), C =27 (4.2%), and D=325 (50.9%). Health-related QoL as assessed by all domains of the SGRQ (p<0.0001) and most but not all domains of the SF-36, circulating proadrenomedullin (p=0.0287), 6 MWD (p<0.0001), exacerbations rate (p< 0.0001), severe exacerbation rate (p<0.0001) and mortality (p<0.0001) differ significantly among the 4 groups. Mortality was highest in the group D (12%) followed by groups A (10%), B (6%). Remarkably, mortality was lowest in group C (0%).CONCLUSION:The combined assessment according to the new GOLD guidelines is only partially associated with quality of life and the risk of future events in COPD.