PURPOSE: To characterize the usefulness of GOLD staging as a predictor of outcomes in COPD patients and to determine the degree to which the GOLD guidelines for treatment are followed in an academic VA hospital.
METHODS: Charts of 484 patients diagnosed with COPD in 2005 were reviewed. COPD medication regimens and GOLD stage by spirometric criteria were recorded. We then documented the occurrence of exacerbations and death over the following 5 years.
RESULTS: The patients studied were largely Caucasian and mostly male, 9.1% were classified as having mild COPD; 41.5% as having moderate disease; 35.5% as having severe disease and 13.9% as having very severe COPD by GOLD guidelines. Over the 5 year follow-up period 32.2% had one or more exacerbation and 31.6% died. Of the patients classified as having mild disease 31% had exacerbations and 20.5 % died; 26% of those classified as moderate disease had exacerbations and 25.4% died; 32.7% of patients with severe disease had exacerbations and 32.7% of them died and 47.1% of very severe disease experienced exacerbations and 54.4% died. The treatment regimen followed GOLD guidelines in 34.1% of patients with mild COPD; 18.9% of patients with moderate disease; 32.7% of patients with severe disease and 45.6% of patients with very severe COPD. In patients where the treatment regimen did not comply with the guidelines, they were mostly overtreated.
CONCLUSIONS: 1) With the exception of the patients with very severe disease, the GOLD staging did not predict rate of exacerbations; 2) Death was predicted more accurately by the GOLD stage; 3) Academic clinicians generally treat in excess of GOLD treatment guidelines.
CLINICAL IMPLICATIONS: Treatment decisions may follow exacerbation rates rather than severity of COPD by spirometry. It is not clear whether this is appropriate or an excessive use of medication.
DISCLOSURE: Hussein Foda: Grant monies (from industry related sources): Novartis
Karen Goldsteen: Grant monies (from industry related sources): Novartis
Raymond Goldsteen: Grant monies (from industry related sources): Novartis
Norman Edelman: Grant monies (from sources other than industry): Novartis
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