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. 2023 Oct 24:18:2335-2339.
doi: 10.2147/COPD.S430344. eCollection 2023.

Exploring the Validity of GOLD 2023 Guidelines: Should GOLD C and D Be Combined?

Christopher Duckworth  1 , Michael J Boniface  1 , Adam Kirk  2 , Thomas M A Wilkinson  2   3   4
Affiliations

Exploring the Validity of GOLD 2023 Guidelines: Should GOLD C and D Be Combined?

Christopher Duckworth et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Introduction: The GOLD (Global Initiative for Chronic Obstructive Lung Disease) 2023 guidelines proposed important changes to the stratification of disease severity using the "ABCD" assessment tool. The highest risk groups "C" and "D" were combined into a single category "E" based on exacerbation history, no longer considering symptomology.

Purpose: We quantify the differential disease progression of individuals initially stratified by the GOLD 2022 "ABCD" scheme to evaluate these proposed changes.

Patients and methods: We utilise data collected from 1529 users of the myCOPD mobile app, a widely used and clinically validated app supporting people living with COPD in the UK. For patients in each GOLD group, we quantify symptoms using COPD Assessment Tests (CAT) and rate of exacerbation over a 12-month period post classification.

Results: CAT scores for users initially classified into GOLD C and GOLD D remain significantly different after 12 months (Kolmogorov-Smirnov statistic = 0.59, P = 8.2 × 10-23). Users initially classified into GOLD C demonstrate a significantly lower exacerbation rate over the 12 months post classification than those initially in GOLD D (Kolmogorov-Smirnov statistic = 0.26; P = 3.1 × 10-2; all exacerbations). Further, those initially classified as GOLD B have higher CAT scores and exacerbation rates than GOLD C in the following 12 months.

Conclusion: CAT scores remain important for stratifying disease progression both in-terms of symptomology and future exacerbation risk. Based on this evidence, the merger of GOLD C and GOLD D should be reconsidered.

Keywords: Global Initiative for Chronic Obstructive Lung Disease; differential disease progression; exacerbation rate.

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Conflict of interest statement

Thomas MA Wilkinson (TMAW) reports a relationship with my mHealth Limited that includes: employment. Adam Kirk reports a relationship with my mHealth Limited that includes: employment. TMAW is Chief Science Officer and cofounder of my mHealth, the developer of the myCOPD app. He has a patent pending to my mHealth. AK is the Medical Director and Data Protection Officer of my mHealth. All other authors declare no competing interests in this work.

Figures

Figure 1
Figure 1
(A) Changes to GOLD group guidelines from 2022 (top) to 2023 (bottom). (B) Average CAT score (top) and average cumulative number of self-reported exacerbation days (bottom) registered in the 12-months post initial GOLD 2022 grouping. An exacerbation day is defined as a unique day where a given user has reported a moderate or severe exacerbation in their daily symptom scores registered in-app.
See this image and copyright information in PMC

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Supplementary concepts