Severity of airflow obstruction in Chronic Obstructive Pulmonary Disease (COPD): proposal for a new classification

Abstract

Current classifications of Chronic Obstructive Pulmonary Disease (COPD) severity are complex and do not grade levels of obstruction. Obstruction is a simpler construct and independent of ethnicity. Using data from the Burden of Obstructive Lung Disease (BOLD) study we constructed an index of severity based on the FEV1/FVC ratio with cut-points dividing the population into four similar sized strata to those created by the GOLD criteria using FEV1. We measured agreement between classifications and validity of the FEV1-based classification in identifying the level of obstruction as defined by the new groupings. We compared the strengths of association of each classification with quality of life, MRC dyspnoea score and the self-reported exacerbation rate. Agreement between classifications was only fair. FEV1-based criteria for moderate COPD identified only 79% of those with moderate obstruction and misclassified half of the participants with mild obstruction as having more severe COPD. Both scales were equally strongly associated with quality of life, exertional dyspnoea and respiratory exacerbations. Severity assessed using the FEV1/FVC ratio is only in moderate agreement with the severity assessed using FEV1 but is equally strongly associated with other outcomes. Severity assessed using the FEV1/FVC ratio is likely to be independent of ethnicity.