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 2017 by the author


Prospective assessment of GOLD 2017
categories and COPD phenotypes
Czech Multicentre Research Database of COPD
Disclosure

• Lectures fees, unrestricted research grants, travel grants, advisory boards


(Angelini CZ, AstraZeneca CZ and CEE, Boehringer Ingelheim CZ and CEE,
GSK CZ and CEE, Novartis CZ and Global)

• No conflict of interest related to presented topic


Agenda

1) Introduction - COPD heterogeneity


2) Data source - Czech Multicentre Research Database (CMRD)
3) Research - Evolution of GOLD 2017 categories and clinical phenotypes
4) Conclusion
1) Introduction
COPD heterogeneity

FEV1
20-0ml/year 25%

50-60ml/year 50%

90-100ml/year 25%

3-5 years

Nishimura AJRCCM 2012, Casanova AJRCCM 2011, and others


„Control panels“ ⇢ GOLD 2017 (A-B-C-D)

COPD control panels


for personalised medicine

Agusti Thorax 2014


Simple „clinical phenotypes“

CEE COHORT

SPANISH COHORT

Miravitlles M, Int J Tuberc Lung Dis 2015 Agusti Thorax 2014 Koblizek V et al, Eur Respir J 2017
„Phenotypical LABELS“

Agusti Thorax 2014


VKoblizek et al. The Distibution of Phenotypes in a Population of Severe COPD, ERS 2014, 2015 a 2016
2) Data source
Czech Multicentre Research Database (CMRD)

• Prospective observational project of Czech Pneumological and


Phthisiological Society (CPPS)
• Moderate-Severe-Very Severe COPD cohort (postBD FEV1 < 60%)
• Primary outcome - all cause mortality
• Secondary outcomes - morbidity and
disease progression during 5-8 years


Our analysis Novotna et al, Int J COPD 2014
3) Research
Evolution of GOLD categories and clinical phenotypes

Summer 2017
Glacier Larsen C - Antarctica
Methods

• COPD subjects with at least 24 months of follow-up


• Assessment of stability GOLD/simple phenotypes classifications
• Theoretical „speculative“ construction of severity classification scales
based on symptoms burden and mortality
Results

• 784 COPD individuals enrolled untill Dec 2016


• postBD FEV1 45 % +- 11.6, 66 years, 73 % ♂
• 292 of them were eligible for prospective (2 years) analysis
Evolution of „new“ GOLD 2017
Evolution of „old“ GOLD 2016
Evolution of clinical phenotypes
2 years stability of „new“ GOLD 2017
2 years stability of „old“ GOLD 2016
2 years stability of clinical phenotypes
Comparison of stability all three classifications
4) Conclusion

• „new“ GOLD was stable in minority of severe COPD pts only


• Stability of „old“ GOLD was significantly higher
• The highest stability was apparent in the simple clinical phenotypes
• Instability does not mean worsening

• „old“ GOLD D was more stable than others (GOLD categories)


• NON-AE a ACO (ACOS) were stable phenotypes
Acknowledgement to all 42 members
of CMRD COPD TEAM

http://clinicaltrials.gov/ct2/show/NCT01923051
http://chopn.registry.cz/index-en.php
email: vladimir.koblizek@fnhk.cz

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