Describing the GOLD Group Distribution and Appropriateness of Therapy in Patients with COPD.

Describing the GOLD Group Distribution and Appropriateness of Therapy in Patients with COPD.

A study by OPRI describing in details the GOLD group distribution in patients with COPD who started their initial treatment and those with established COPD has been recently published in the Journal EClinicalMedicine.1

The 2019 update of the Global Obstructive Lung Disease initiative (GOLD) recommendation separated the treatment recommendation algorithm for both initial and follow-up treatment of COPD. Previous studies had been conducted on COPD treatment appropriateness within GOLD groups as defined by the recommendation based on the patients’ symptom severity and history of exacerbation. However, these studies had mostly focused exclusively on patients already on maintenance therapy, potentially leading to erroneous treatment due to the effects of therapy. To this end, OPRI conceived this systematic, investigative and experimental (SIE) study to characterise patients across the GOLD group distribution, in both established and newly treated COPD patients, to improve treatment. This novel study is the first of its kind in Singapore.

Primary care patient records stored within the OPCRD were extracted to identify the two population of patients with COPD: those initiating their first treatment and those with established COPD. The distribution patterns of GOLD groups in both patient cohorts were analysed. We further assessed the appropriateness of the therapy based on GOLD 2019 recommendation, the risk of exacerbation across GOLD groups and changes in the patients’ GOLD groups over the next 2 years.

A total of 11,409 established COPD patients and 699 starting COPD therapy were identified. Of the established COPD patients, 44·3%, 25·7%, 13·8% and 16·2% were classified as GOLD groups A, B, C & D respectively. The distribution was 45·2%, 28·5%, 15·7% and 10·6% among patients initiating therapy. In both patient cohorts, substantial movement of GOLD groups within 2 years was observed. Over-treatment was frequent in patients at lower severity groups in both cohorts, most commonly due to additional treatment with inhaled corticosteroid, likely driven by the presence of asthma. Patients in more severe GOLD groups were at higher risk of exacerbation in both cohorts.

Technical risks not readily resolved by a competent expert were involved as there was a need to identify a sufficient number of patients within the data source and a need for identification of a study design capable of answering the correct research question.

In conclusion, the study acquired new knowledge showing that GOLD group distributions were similar between both established COPD and newly treated patients, with the majority being at group A (lowest risk of exacerbation). In both cohorts, the GOLD grouping did predict patients’ risk of exacerbation and movement between GOLD groups within 2 years were common. Over-treatment was observed to be common but was likely appropriate in a fraction of cases driven by other factors guiding the clinician’s prescribing consideration.

Full-text of the article and expert commentary on this research,2 provided by Prof PMA Caverley, are available in The Lancet website.

  1. Halpin DMG, de Jong HJI, Carter V, et al. Distribution, Temporal Stability and Appropriateness of Therapy of Patients With COPD in the UK in Relation to GOLD 2019. EClinicalMedicine
  2. Calverley PMA. Meeting the GOLD Standard: COPD Treatment in the UK Today. EClinicalMedicine 2019 doi: 10.1016/j.eclinm.2019.07.016