• Peter Lange, Jacob Louis Marott, Jørgen Vestbo, Kim Rose Olsen, Truls Sylvan Ingebrigtsen, Morten Dahl, and Børge Grønne Nordestgaard.
• Section of Social Medicine, Department of Public Health, Copenhagen University, P.O. Box 2099, Øster Farimagsgade 5, DK-1014 Copenhagen K, Denmark. peter.lange@sund.ku.dk
• Am. J. Respir. Crit. Care Med.. 2012 Nov 15;186(10):975-81.

RationaleThe new Global Initiative for Obstructive Lung Disease (GOLD) stratification of chronic obstructive pulmonary disease (COPD) into categories A, B, C, and D is based on symptoms, level of lung function, and history of exacerbations.ObjectivesTo investigate the abilities of this stratification to predict the clinical course of COPD.MethodsTwo similar population studies were performed in an area of Copenhagen including 6,628 individuals with COPD.Measurements And Main ResultsThe patients were monitored for an average period of 4.3 years regarding COPD exacerbations, hospital admissions, and mortality. The percentages of individuals experiencing a COPD exacerbation during the first year of observation were 2.2% in group A, 5.8% in group B, 25.1% in group C, and 28.6% in group D. One- and 3-year mortality rates were 0.6 and 3.8%, respectively, in group A, 3.0 and 10.6% in group B, 0.7 and 8.2% in group C, and 3.4 and 20.1% in group D. Groups B and D, characterized by a higher degree of dyspnea than groups A and C, had five to eight times higher mortality from cardiovascular disease and cancer than did groups A and C.ConclusionsThe new stratification performs well by identifying individuals at risk of exacerbations. Surprisingly, subgroup B, characterized by more severe dyspnea, had significantly poorer survival than group C, in spite of a higher FEV(1) level. This subgroup warrants special attention, as the poor prognosis could be caused by cardiovascular disease or cancer, requiring additional assessment and treatment.

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