Obstructive Lung Diseases |

GOLD Stage and Treatment in COPD: A 500 Patient Point Prevalence Study FREE TO VIEW

Joshua Wald, MD; Katherine Safka, MD; Hongyu Wang; Luke McIvor, MD; Andrew McIvor, MD
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McMaster University, Hamilton, ON, Canada

Chest. 2015;148(4_MeetingAbstracts):700A. doi:10.1378/chest.2221338
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: The GOLD strategy recommends using a combination of symptoms and risk of exacerbation to classify patients into four categories to guide treatment decisions along with a stepwise increase in therapy. Our objectives were to identify the GOLD stage of patients in respirology outpatient clinics and assess how treatment compares to guideline recommendations.

METHODS: We performed a point prevalence study using a convenience sample of 500 patients with COPD from a single tertiary care outpatient respirology clinic.

RESULTS: 553.2% of patients were male, the mean age of participants was 68.4 (SD 9.8), the mean FEV1 was 48.9% (SD19.1). All patients had a history of smoking with a mean pack year history of 55.4 (SD31.8). 32.2% were current smokers while 67.8% were ex-smokers. Patients GOLD classification was determined based on mMRC, CAT and self reported exacerbation history. 7.6% were GOLD group A, 29.6% group B, 4.3% group C and 58.4% group D. Treatment: Data was collected on each patient’s current regular COPD inhaler regimen 71% of patients were on a LAMA, 67% of patients were on an ICS/LABA combination inhaler, 68% were on SABA, 11.4% were on SAMA, 4.4% were on LABA without ICS and 1% were on PDE4 inhibitors. 37.2% of patients in GOLD category A were on triple therapy with LAMA and ICS/LABA, 52.4% in group B, 75.0% of patients in group C and 67.3% of patients in group D

CONCLUSIONS: In this 500 patient point prevalence study we report a low proportion of patients in GOLD group C and high level of ICS/LABA and triple therapy use throughout all GOLD categories.

CLINICAL IMPLICATIONS: We propose a modification to GOLD classification consisting of a three-group categorization with the goal of simplifying the algorithm and reducing the utilization of ICS in patients who are unlikely to benefit from them. A pyramid, with Groups A and B forming the base, with treatment directed at optimal bronchodilation. A single group combining all patients with high risk for exacerbations forms the top of the pyramid. Treatment in this group is targeted at maximal bronchodilation and exacerbation prevention.

DISCLOSURE: Joshua Wald: University grant monies: Novartis Pharmaceuticals: CME through department Katherine Safka: University grant monies: Novartis Pharmaceuticals: CME through department Andrew McIvor: Grant monies (from industry related sources): Novartis Pharmaceuticals: CME, Advisory Board and Research Funding The following authors have nothing to disclose: Hongyu Wang, Luke McIvor

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