TY - JOUR T1 - Heterogeneity of group D in the new GOLD classification of COPD JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.congress-2016.PA4174 VL - 48 IS - suppl 60 SP - PA4174 AU - Richa Mittal AU - Sunil Chhabra Y1 - 2016/09/01 UR - http://erj.ersjournals.com/content/48/suppl_60/PA4174.abstract N2 - Introduction: Patients with higher of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages (III or IV) or past frequency of exacerbations (> 2/year)/hospitalizations (>1/year) are categorized into group D in the 2011 GOLD classification. As spirometry is known to poorly predict the risk of exacerbations, we hypothesized that patients categorized by these criteria differ in clinical characteristics and risk predictions.Methods: Disease severity was classified in 400 COPD patients using modified Medical Research Council (mMRC) grading of dyspnoea and COPD Assessment Test (CAT) followed by spirometry. Group D patients were sub-grouped based on categorization by GOLD stages (D1), exacerbation history (D2) and by both criteria (D3). ADO (Age, Dyspnea, Obstruction) index was computed as a predictor of all-cause mortality risk.Results: Group D (n=249) were sub-grouped into D1 (131-52.6%), D2 (48-19.3%) and D3 (70-28.1%). Age, gender distribution, body mass index, smoking and comorbidities did not differ among these. CAT scores among D1 patients (17.6±6.9) were lower than the others (D2: 22.2±6.7 and D3: 23.9±7.3) (p<0.0001). Post-bronchodilator lung function was lower in groups D1 and D3 compared to D2 (p<0.0001). D3 subgroup had more patients with higher grades of dyspnea. ADO index scores were higher in groups D1 and D3 compared to D2 (p<0.0001).Conclusions: Patients with frequent exacerbations have poorer health status despite a better lung function. They however have a lower all-cause mortality risk compared to the other subgroups. Thus, with patients differing in clinical characteristics and risk predictions, group D of the new GOLD classification is not homogenous which has therapeutic implications. ER -