Chest
Volume 130, Issue 2, August 2006, Pages 318-325
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Original Research: COPD
Can Global Initiative for Chronic Obstructive Lung Disease Stage 0 Provide Prognostic Information on Long-term Mortality in Men?

https://doi.org/10.1378/chest.130.2.318Get rights and content

Study objectives

To determine if the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 0 (subjects at risk for COPD) provides information about long-term mortality risk.

Design, setting, and participants

From 1972 to 1975, clinical, physiologic, and biochemical parameters including respiratory symptoms, spirometry, and physical fitness were measured in 1,999 healthy men aged 40 to 59 years in an occupational cohort, of whom 1,623 had acceptable spirometry findings. In a proportional hazards model with follow-up until 2000, we assessed all-cause mortality according to GOLD stage 0, I, II, and III compared with “normal” subjects, after adjusting for known risk factors and potential confounders.

Results

After 26 years (range, 25 to 27 years), 615 men (38%) had died. In multivariate proportional hazards models, GOLD stage 0 subjects had a nonsignificantly increased hazard of death (hazard ratio [HR], 1.19; p = 0.21) after adjustment for age, smoking, physical fitness, body mass index, systolic BP, and serum cholesterol. Similarly, subjects in GOLD stage I (HR, 1.30; p = 0.05) and stage II (HR, 1.77; p < 0.0001) had increased all-cause mortality. When expanding GOLD stage 0 to comprise patients with any respiratory symptom in a sensitivity analysis, the HR for all-cause mortality increased (HR, 1.35; p = 0.03).

Conclusion

There probably is an excess mortality among GOLD stage 0 subjects compared to symptom-free subjects; however, this should be interpreted cautiously and the results vary with the definition of the GOLD stage 0. Subjects in GOLD stage I or stage II had higher mortality than symptom-free subjects.

Section snippets

MATERIALS AND METHODS

In 1972, all healthy man aged 40 to 59 years from five companies in Oslo, Norway were invited to a cardiovascular screening survey (n = 2,341), and 2,014 men (86%) consented to participate. The companies included Siemens AS (Oslo, Norway), and four organizations from the public sector (Norwegian Postal Services, Norwegian Telecom, Norwegian Customs and Excise, and Norwegian State Railways). The participants had to be free from known or suspected heart disease, drug-treated hypertension,

RESULTS

Acceptable spirometric recordings according to our criteria were available in 1,623 of the 2,014 apparently healthy men, 84% of the 1,924 spirograms reviewed. The sample mean (SD) age was 49.8 ± 5.5 years, mean unadjusted FEV1 was 3.50 ± 0.75 L, and 43.4% were current smokers (Table 1). Advanced GOLD stages were associated with high rates of current smoking (Table 1). At the follow-up examination after on average 8 years (n = 1,423, 88% of the cohort), 6% of never-smokers had started smoking

DISCUSSION

In this study of working apparently healthy, middle-aged men, multivariate models show that GOLD stage 0 represents subjects with a better long-term prognosis than subjects in stages I, II, and III, with no significant excess long-term mortality than those without cough or phlegm. The relative prognosis between the stages depends on the number of covariates in the models. The novelty of this article is that the outcome is mortality, rather than a proxy such as transfer from GOLD stage 0 to

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