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Spirometery Interpretation Strategies in the Diagnosis and Severity Classification of Chronic Obstructive Pulmonary Disease: Discordance Between GOLD and ATS/ERS 2005 Criteria and Treatment Implications FREE TO VIEW

Ameer Rasheed, MD; Viswanath Vasudevan, MD; Saleem Shahzad, MD; Farhad Arjomand, MD; Scott Reminick, MD
Chest. 2011;140(4_MeetingAbstracts):888A. doi:10.1378/chest.1118428
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PURPOSE: GOLD and ATS/ERS use different criteria to diagnose and to stratify COPD severity. COPD is diagnosed when FEV1/FVC% <70( GOLD) and when the FEV1/FVC% < LLN based on NHANES III reference equations(ATS).The severity classification: GOLD Vs ATS; Mild >80% Vs >70%; Moderate: 50-80% Vs 50-70%. GOLD treatment recommendations are as needed inhaled short acting bronchodilator for mild disease and maintenance long acting bronchodilators for moderate severity. This results in discordant diagnoses, severity classification and conflicting treatment recommendations. The purpose of this study is to examine the prevalence of the discordance between the two diagnostic criteria, severity classification and its implication on therapy.

METHODS: We retrospectively reviewed the PFT report of all patients with clinical diagnosis of COPD during the time period between 01/09 to 01/11. We included patients who satisfied either GOLD and/or ATS criteria. Patients with asthma were excluded.

RESULTS: Of 217 patients with COPD, there was a discordance in 24(11%). Twenty with a median age of 64 years met the GOLD criteria but not the ATS. Four patients with a median age of 41 years met the ATS but not the GOLD. Among patients who satisfied both diagnostic criteria, 39 were categorized as mild by ATS but moderate by GOLD. These patients had best FEV1 between 70-80% of mean NHANES-III reference values.

CONCLUSIONS: The study documented discordance between GOLD and ATS in the diagnosis and severity classification of COPD. Applying the ATS definition as the standard reference, COPD diagnosis by GOLD criteria across all ages, leads to overdiagnosis of COPD in older patients and underdiagnosis in younger patients.

CLINICAL IMPLICATIONS: Conflicting diagnostic criteria, severity classification and treatment recommendations creates dilemma in patient care, especially in patients with borderline diagnostic criteria and overlapping severity classification. There is a need for a joint GOLD/ATS/ERS consensus statement to resolve the conflicts.

DISCLOSURE: The following authors have nothing to disclose: Ameer Rasheed, Viswanath Vasudevan, Saleem Shahzad, Farhad Arjomand, Scott Reminick

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