The Comparison of Clinical Variables in Two Classifications: GOLD 2017 Combined Assessment and Spirometric Stage of Chronic Obstructive Pulmonary Disease / 결핵및호흡기질환

BACKGROUND: There are limited number of studies that investigate clinical variables instead of chronic obstructive lung disease (COPD) management according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017 classification. The aim of the study was to investigate whether there was a difference between GOLD 2017 classification and spirometric stage in clinical variables in patients with COPD. The data of 427 male patients with stable COPD were investigated retrospectively. METHODS: Patients were allocated into combined assessment of GOLD 2017 and spirometric stage. Age, amount of smoking, pulmonary function, modified Medical Research Council (mMRC), incremental shuttle walk test (ISWT), Hospital Anxiety-Depression Scale (HADS), St. George's Respiratory Questionnaire (SGRQ), body mass index (BMI), and fat free mass index (FFMI) were recorded. RESULTS: Seventy-three (17%) patients were in group A, 103 (24%) constituted group B, 38 (9%) were included in group C, and 213 (50%) comprised group D according to the combined assessment of GOLD 2017. Twenty-three patients (5%) were in stage 1, 95 (22%) were in stage 2, 149 (35%) were in stage 3, and 160 (38%) were in stage 4 according to spirometric stage. According to GOLD 2017, age, amount of smoking, mMRC, BMI, FFMI, SGRQ, HADS, forced vital capacity, forced expiratory volume in 1 second (FEV1), and ISWT were significantly different between groups. Ages, amount of smoking, FFMI, BMI, HADS of group A were different from B and D. Smiliar values of FEV1 were found in A–C and B–D. A and C had smiliar ISWT. According to spirometric stage, BMI, FFMI of stage 4 were statistically different. mMRC, ISWT, and SGRQ of stages 3 and 4 were different from other stages, amongst themselves. FEV1 was correlated with mMRC, SGRQ, anxiety scores, BMI, FFMI, and ISWT. CONCLUSION: This study showed that the GOLD ABCD classification might not represent the severity of COPD sufficiently well in terms of lung function or exercise capacity. The combination of both spirometric stage and combined assessment of GOLD 2017 is important, especially for estimating clinical variables.

Comprehensive out-patient pulmonary rehabilitation: treatment outcomes in early and late stages of chronic obstructive pulmonary disease

The aim was to evaluate the outcomes of a comprehensive pulmonary rehabilitation [PR] in chronic obstructive pulmonary diseases [COPD] and to establish whether in early disease stage PR is as effective as in late stages of disease. A total of 55 stable COPD patients, 28 with early and 27 with late disease stages, were assessed. Patients underwent a comprehensive out-patient PR program for 8 weeks. To elucidate the effects of PR and compare the level of improvement; lung function, dyspnea sensation [Medical Research Council [MRC]], body composition [body mass index [BMI], fat free mass [FFM], fat free mass index [FFMI]], exercise capacity [incremental shuttle walking test, endurance shuttle walking test], health related quality of life [HRQoL] with St. George Respiratory Disease Questionnaire, psycohological status [Hospital anxiety-depression [HAD] scale] were evaluated before and after PR. At the end of PR in the early disease stage group, the improvement in forced vital capacity [FVC] reached a statistically significant level [P< 0.05]. In both disease stages, there were no significant differences in BMI, FFM, and FFMI. The decrease in exertional dyspnea for the two groups evaluated with the modified BORG scale were not found statistically significant, though the dyspnea scores evaluated with MRC showed significant improvements[P<0.001]. HRQoL and exercise capacity were significantly improved for the two groups [P<0.001]. Psychological status evaluated with the HAD scale improved after PR [P<0.001] both in early and late stages. Gainings in the study parameters did not differ in the early and the late disease stages. These results showed that patients with COPD had benefited from a comprehensive PR program in an out-patient setting regardless of disease severity. Even patients with earlier stage of disease should be referred and encouraged to participate in a PR program