Is COPD a Progressive Disease? A Long Term Bode Cohort Observation
de-Torres JP (1), Marín JM (2), Pinto-Plata V (3), Divo M (3), Sanchez-Salcedo P (1), Zagaceta J (1), Zulueta JJ (1), Berto J (1), Cabrera C (4), Celli BR (3), Casanova C (5).
(1) Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
(2) Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragones Ciencias Salud & CIBERES, Zaragoza, Spain.
(3) Pulmonary Department, Brigham and Women's Hospital. Harvard Medical School, Boston, MA, United States of America.
(4) Pulmonary Department, Hospital Universitario Jose Negrín, Las Palmas de Gran Canaria, Spain.
(5) Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain.
The Global Initiative for Obstructive Lung Diseases (GOLD) defines COPD as a disease that is usually progressive. GOLD also provides a spirometric classification of airflow limitation. However, little is known about the long-term changes of patients in different GOLD grades.
Explore the proportion and characteristics of COPD patients that change their spirometric GOLD grade over long-term follow-up.
Patients alive for at least 8 years since recruitment and those who died with at least 4 years of repeated spirometric measurements were selected from the BODE cohort database.
We purposely included the group of non survivors to avoid a "survival selection" bias. The proportion of patients that had a change (improvement or worsening) in their spirometric GOLD grading was calculated and their characteristics compared with those that remained in the same grade.
A total of 318 patients were included in the survivor and 217 in the non-survivor groups. Nine percent of survivors and 11% of non survivors had an improvement of at least one GOLD grade. Seventy one percent of survivors and non-survivors remained in the same GOLD grade. Those that improved had a greater degree of airway obstruction at baseline.
In this selected population of COPD patients, a high proportion of patients remained in the same spirometric GOLD grade or improved in a long-term follow-up. These findings suggest that once diagnosed, COPD is usually a non-progressive disease.
CITATION PLoS One. 2016 Apr 21;11(4):e0151856. doi: 10.1371/journal.pone.0151856. eCollection 2016.