The distribution of COPD in general practice using three different GOLD classification

Introduction: Over the past 10 years, three classifications of COPD patients have been used. Their comparison is important for the appointment of modern treatment and assessment of the prognosis of the disease. Aim: Compare the distribution of patients with COPD according to the three GOLD classifications. Results: A database of 125 primary-care COPD patients was used to determine COPD distribution and characteristics according to the three GOLD classification. All patients were personally examined and interviewed by a pulmonologist. GOLD 2017 group distributions were: A (low risk and fewer symptoms) 3.2%, B (low risk and more symptoms) 11.2%, C (high risk and fewer symptoms) 0.8% and D (high risk and more symptoms) 84,8%. GOLD 2011 group distributions were: 0%, 0%, 4%, 96%, respectively. This is in contrast with GOLD 2007 stage classification: I (mild) 6.4%, II (moderate) 29,6%, III (severe) 43,2% and IV (very severe) 20,8%. Most of the clinical trials that make up the evidence base for COPD treatment have been built on the spirometric gradation of GOLD severity. At the same time, the GOLD 2017 classification excluded spirometry in the choice of therapy. This creates a problem in the appointment, for example, of inhaled steroids, the use of which is recommended with FEV1 <50%. Conclusions: It is advisable to post-hoc analysis of previous clinical studies, or to conduct new comparative studies, to confirm the effectiveness of drugs of different classes in relation to the new classification of COPD.