A New Approach to Classification of Disease Severity and Progression of COPD

作者：Mannino David M^*; Diaz Guzman Enrique; Pospisil John

来源：Chest, 2013, 144(4): 1179-1185.

DOI：10.1378/chest.12-2674

Background: Most current classification schemes for COPD use lung function as the primary way of classifying disease severity and monitoring disease progression. This approach misses important components of the disease process. %26lt;br%26gt;Methods: We evaluated existing data to develop a classification scheme for COPD using measures beyond lung function, including respiratory symptoms, exacerbation history, quality-of-life assessment, comorbidity, and BMI. We then applied this scheme to data from the Lung Health Study, calculating a score for study subjects in year 1 and year 5 of the study, along with the difference between year 1 and year 5. %26lt;br%26gt;Results: We developed a four-point scale ranging from 1.00 (mild) to 4.00 (very severe). In year 1 of the study, the mean COPD score was 1.76; in year 5 it was 1.82. The mean difference from year 1 to year 5 was an increase (worsening) of 0.06 and a range from -1.0 to 1.6. The COPD score at year 1, year 5, and the difference between these scores were all predictive of mortality at follow-up. For example, the 14.0% of subjects whose score improved by at least 0.25 between year 1 and 5 had decreased mortality compared with those with stable scores (between -0.25 and 0.25; hazard ratio, 0.6; 95% CI, 0.4, 0.8). %26lt;br%26gt;Conclusions: A COPD severity score that includes components in addition to lung function and allows for both improvement and worsening of disease may provide additional guidance to COPD classification, management, and prognosis.

• 出版日期2013-10