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Characteristics, stability and outcomes of the 2011 GOLD COPD groups in the ECLIPSE cohort

Research output: Contribution to journalArticle

  • Alvar Agusti
  • Lisa D. Edwards
  • Bartolome Celli
  • William MacNee
  • Peter M. A. Calverley
  • Hana Muellerova
  • David A. Lomas
  • Emiel Wouters
  • Per Bakke
  • Steve Rennard
  • Courtney Crim
  • Bruce E. Miller
  • Harvey O. Coxson
  • Julie C. Yates
  • Ruth Tal-Singer
  • Jorgen Vestbo
  • ECLIPSE Investigators

Related Edinburgh Organisations

Original languageEnglish
Pages (from-to)636-646
Number of pages11
JournalEuropean Respiratory Journal
Issue number3
Publication statusPublished - Sep 2013


The 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) into four groups (A to D).

We explored the characteristics, stability and relationship to outcomes of these groups within the ECLIPSE study (Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points) (n=2101).

Main results showed that: 1) these groups differed in several clinical, functional, imaging and biological characteristics in addition to those used for their own definition; 2) A and D groups were relatively stable over time, whereas groups B and C showed more temporal variability; 3) the risk of exacerbation over 3 years increased progressively from A to D, whereas that of hospitalisation and mortality were lowest in A, highest in D and intermediate and similar in B and C, despite the former having milder airflow limitation. The prevalence of comorbidities and persistent systemic inflammation were highest in group B.

The different longitudinal behaviour of group A versus B and C versus D (each pair with similar forced expiratory volume in 1 s (FEV1) values supports the 2011 GOLD proposal of assessing COPD patients by more than FEV1 only. However the assumption that symptoms do not equate to risk appears to be naive, as groups B and C carry equally poor clinical outcomes, though for different reasons.

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