TY - JOUR T1 - A new paradigm for classification of disease severity and progression of COPD JF - European Respiratory Journal JO - Eur Respir J VL - 40 IS - Suppl 56 SP - P4746 AU - David Mannino AU - Enrique Diaz-Guzman AU - John Pospisil Y1 - 2012/09/01 UR - http://erj.ersjournals.com/content/40/Suppl_56/P4746.abstract N2 - Background: The current classification scheme for COPD uses lung function to classify disease severity and monitor disease progression. This scheme does not capture other important components of the disease process, nor does it allow for improvement of disease status.Methods: We evaluated existing data to develop a classification scheme for COPD using measures beyond lung function, including respiratory symptoms, exacerbation history, quality of life assessment, comorbidity, and body mass index. We then applied this classification to data from the Lung Health Study, calculating a score for study subjects in year 1 and year 5 of the study, along with the difference between year 1 and year 5.Results: We developed a 4 point scale ranging from 1.00 (mild) to 4.00 (very severe). In year 1 of the study, the mean COPD score was 1.76 (standard deviation [SD] 0.35), in year 5 it was 1.82 (SD 0.38). The mean difference from year 1 to year 5 was an increase (worsening) of 0.06 (SD 0.37), and a range from -1.0 to 1.6. The COPD score at year 1, year 5, and the difference between these scores were all predictive of mortality at follow-up. For example, the 14.0% of subjects whose score improved by at least 0.25 between year 1 and 5 had decreased mortality compared to those with stable scores (between -0.25 and 0.25, hazard ratio 0.6, 95% confidence interval 0.4, 0.8). Conversely, those whose score worsened by 0.75 or more points had increased mortality (HR 1.7, 95% CI 1.2, 2.5).Conclusions: A COPD score that includes components in addition to lung function and allows for both improvement and worsening of disease may provide additional guidance to COPD classification, management, and prognosis. ER -