Comparison of Global Initiative for Chronic Obstructive Lung Disease (GOLD) Severity Classifications in a Lung Partners Population

Abstract

Background:

Lung Partners is an in-patient Primary Respiratory Care COPD Disease Management program. Patients were enrolled during an admission for a COPD exacerbation. All patients had spirometry and GOLD staging. Screening for anxiety, depression, sleep disorders, Literacy, and functionality among others were performed. We wanted to learn how the original or revised GOLD staging compared in our more severe population.

Methods:

All Lung Partner screening data and spirometry were downloaded into a database. Patients were staged both by original and current criteria. We had a population of patients with clinical diagnosis of COPD that had no obstruction (NO) on spirometry. Data tables were created for Stages III, IV, C, D, and NO for comparisons.

Results:

The number of patients in Stages III, IV, C, D, and NO were 176, 147, 33, 462 and 73. There was a significant difference in both anxiety and depression average scores between C and D patients. Anxiety and depression scores at or above 10 require intervention. Average anxiety scores: C=4.0 D=8. 18, % of patients requiring intervention: C=9. 1% D=30.7%. Average depression scores: C=4.59 D=8.98, % of patients requiring intervention: C=9. 1% D=37.9% (all P<.001). NO group's anxiety and depression scores were similar to the D group. COPD Assessment Test (CAT) scores correlated with anxiety and depression scores: Spearman Correlation Coefficients, anxiety vs CAT: r=0.39220, P<0.0001, depression vs CAT: r=0.38483, P<0.0001. Sleep score triggers for the NO group were lower than the other groups: NO=37. 3%, C=60.6%, III=56. 1%, IV=53.9% (P< .02), D=50.1 (P=NS). C patients tended to have better Karnofsky performance scores. There were no differences in Literacy scores. NO patients had the following stages: I=2.8%, II=61.1%, III=30.6%, IV=5.6%, C=10%, D=90%.

Conclusions:

Anxiety and Depression are more pronounced as symptoms increase. A high CAT score can be used as an indicator to look for underlying depression and anxiety. Patients with clinical COPD without obstruction on spirometry have significant anxiety and depression. Both GOLD staging criteria are useful in evaluating our population.

Disclosures:

Acevedo – Sunovion Advisory Board, and Monaghan Medical.