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

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Title: Severity of airflow obstruction in Chronic Obstructive Pulmonary Disease (COPD): proposal for a new classification
Authors: Coton,, S
Vollmer, WM
Bateman, E
Marks, GB
Tan, W
Mejza, F
Juvekar, S
Janson, C
Mortimer, K
Mahesh, PA
Buist, AS
Burney, PGJ
Item Type: Journal Article
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.
Issue Date: 11-Aug-2017
Date of Acceptance: 8-Jun-2017
URI: http://hdl.handle.net/10044/1/49061
DOI: https://dx.doi.org/10.1080/15412555.2017.1339681
ISSN: 1541-2555
Publisher: Taylor & Francis
Start Page: 469
End Page: 475
Journal / Book Title: Journal of Chronic Obstructive Lung Disease
Volume: 14
Issue: 5
Copyright Statement: This is an Accepted Manuscript of an article published by Taylor & Francis Group in Journal of Chronic Obstructive Lung Disease on 11 Aug 2017, available online at: http://www.tandfonline.com/10.1080/15412555.2017.1339681
Sponsor/Funder: Department of Health
Commission of the European Communities
Commission of the European Communities
Wellcome Trust
Commission of the European Communities
Kaiser Foundation Hospitals,Center for Health Research
Sociedade Portuguesa de Pneumologia
Tartu University Hospital
Commission of the European Communities
Wellcome Trust
Ciro Horn
Bupa Foundation
Medical Research Council (MRC)
BUPA FOUNDATION
GlaxoSmithKline Services Unlimited
Medical Research Council (MRC)
British Lung Foundation
Wellcome Trust
Medical Research Council (MRC)
Funder's Grant Number: 0120016
LSHB-CT-2006-018996
FOOD-CT-2005-514000
083836/Z/07/Z
FOOD-CT-2004-506378
DHTBX_P19127
DHTBX_P18236
DHTBX_P19125
Grant Agreement No. 2005121
089405/Z/09/Z
DHTBX_P19121
TBF-08-024
G0901214
N/A
HZC115398
MR/J000108/1
PO Nr 28001631
105603/Z/14/Z
MR/M501669/1
Keywords: Epidemiological studies
GOLD classification
method comparison
spirometry
Burden of Obstructive Lung Disease Study investigators
Respiratory System
Publication Status: Published online
Appears in Collections:National Heart and Lung Institute