Spirometric Criteria for Chronic Obstructive Pulmonary Disease in Clinical Trials of Pharmacotherapy

COPD
Carlos A Vaz FragosoPeter H Van Ness

Abstract

Clinical trials of pharmacotherapy in chronic obstructive pulmonary disease (COPD) often include older persons with moderate-to-severe airflow-obstruction, as defined by the Global Initiative for chronic Obstructive Lung Disease (GOLD). In this context, spirometric airflow-obstruction establishes COPD. Because GOLD misidentifies COPD and its severity in older persons, we set out to apply more age-appropriate spirometric criteria from the Global Lung function Initiative (GLI) in a prior clinical trial of COPD pharmacotherapy, specifically the Towards a Revolution in COPD Health (TORCH) trial - N = 6,112, mean age 65 years. In the TORCH trial, which enrolled GOLD-defined moderate COPD (26.2%, n = 1,200) and GOLD-defined severe COPD (73.8%, n = 4,511), the GLI reclassification yielded a higher frequency of severe COPD (89.6%, n = 5,474), the inclusion of restrictive-pattern (6.9%, n = 420) and, in turn, a very low frequency of moderate COPD (3.5%, n = 212). These GLI reclassification results suggest that GOLD-based enrollment criteria for the TORCH trial may have assembled a cohort that was: 1) less likely to respond to COPD pharmacotherapy, given the greater representation of severe COPD, very minor representation of moderate COP...Continue Reading

References

Oct 17, 2002·JAMA : the Journal of the American Medical Association·Steven R CummingsDennis M Black
Feb 23, 2007·The New England Journal of Medicine·Peter M A CalverleyUNKNOWN TORCH investigators
Nov 17, 2007·American Journal of Respiratory and Critical Care Medicine·Sanja StanojevicTim J Cole
May 4, 2010·The European Respiratory Journal·R PellegrinoM Mondino
Nov 19, 2011·Journal of the American Geriatrics Society·Carlos A Vaz FragosoThomas M Gill
Dec 6, 2011·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Carlos A Vaz Fragoso, Thomas M Gill
Jan 24, 2012·The European Respiratory Journal·Carlos A Vaz FragosoThomas M Gill
Jun 30, 2012·The European Respiratory Journal·Philip H QuanjerUNKNOWN ERS Global Lung Function Initiative
Nov 28, 2012·The American Journal of Medicine·Carlos A Vaz FragosoJohn Concato
Mar 23, 2013·The European Respiratory Journal·Philip H QuanjerJeffrey J Pretto
Aug 31, 2013·The European Respiratory Journal·Philip H QuanjerPiotr W Boros
Feb 6, 2015·The European Respiratory Journal·Martin R Miller
Feb 6, 2015·The European Respiratory Journal·Philip H QuanjerBruce R Thompson
Jun 27, 2015·American Journal of Respiratory and Critical Care Medicine·Carlos A Vaz FragosoJohn Concato
Nov 6, 2015·American Journal of Respiratory and Critical Care Medicine·Carlos A Vaz FragosoJohn Concato
Jan 28, 2017·American Journal of Respiratory and Critical Care Medicine·Claus F VogelmeierAlvar Agustí
Mar 18, 2017·American Journal of Respiratory and Critical Care Medicine·Elena TejeroFrancisco García-Río
Jul 13, 2017·Respiratory Care·Carlos A Vaz FragosoPeter H Van Ness
Nov 3, 2017·American Journal of Respiratory and Critical Care Medicine·Carlos A Vaz FragosoVito Brusasco

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Citations

Jul 18, 2019·Journal of the European Academy of Dermatology and Venereology : JEADV·K KridinK T Amber
May 3, 2019·Respiratory Medicine·Carlos A Vaz FragosoPeter H Van Ness

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