| Objective:Compared with the 2016 Global Initiative for Chronic Obstructive Lung Disease(GOLD),there have been significant changes in the GOLD 2017 classification.The purpose of this study was to analyze the changes in clinical characteristics of the new A-B-C-D system and to explore its impact on initial treatment options for patients with stable chronic obstructive pulmonary disease(COPD).Method:The specific steps are as follows:1.Screening of patients with stable COPD who visited our outpatient clinic from September 2017 to October 2018.A total of 256patients with stable COPD were screened,mainly male patients,242 males(94.5%)and 14 females(5.5%),and the average age is 68.15±7.96 years.Inquired and recorded the medical history of eligible patients in detail,complete blood test,lung function test,m MRC and CAT.2.According to GOLD 2016 and 2017 assessment tools,patients were divided into ABCD groups.3.Demography and clinical characteristics were compared between old and new groups A–D.4.Compare the differences in initial treatment options between the groupings of the patients by the two assessment tools.SPSS 21.0 software was used for statistical processing of the obtained data.Result:According to the GOLD 2016 assessment tool,the distribution of the patients was 94(36.72%)in group A,20(7.81%)in group B,66(25.78%)in group C,and 76(29.69%)in group D.According to the GOLD 2017 assessment tool,the distribution of the patients was 136(53.13%)in group A,58(22.66%)in group B,24(9.38%)in group C,and 38(14.84%)in group D.After McNemar-Bowker test,there was significant statistical difference between the two grouping methods(χ~2=80.00 P<0.01).Kappa test showed that the two classification systems had a certain degree of consistency(k=0.57 P<0.01).In the GOLD 2017,42 subjects in Group C were reclassified into Group A,while 38 subjects in Group D were reclassified into Group B.Based on GOLD 2020 recommendations for initial drug therapy,198 patients(77.34%)in the GOLD 2016 group were treated with a single bronchodilator,24patients(9.38%)were treated with dual bronchodilator,and 34 patients(13.28%)were treated with inhaled corticosteroids(ICS)and long-acting beta2-agonists(LABA),226 patients(88.28%)in the GOLD 2017 group were treated with a single bronchodilator,14(5.47%)were treated with dual bronchodilator,and 16(6.25%)were treated with ICS and LABA,the McNemar-Bowker test showed a significant statistical difference between the two groups(χ~2=28.00 P<0.01).10patients stepped down from using a double bronchodilator to a single bronchodilator.18 Patients descended from the use of ICS combined with LABA to the use of a single bronchodilator.Conclusion:1.Compared to the GOLD 2016 assessment tool,GOLD2017 caused a change in the grouping results.GOLD 2017 assessment tool reassigned patients from high-risk groups(group C and group D)to low-risk groups(group A and group D).42 subjects in Group C were reclassified into Group A,while 38 subjects in Group D were reclassified into Group B.2.Compared with GOLD 2016 assessment tool,GOLD 2017 changes the initial treatment options of patients with stable COPD.Some patients treated with dual bronchodilators or ICS combined with LABA need to be downgraded to single bronchodilator therapy.However,whether step-down treatment can benefit such patients need further study. |
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