Adequate Patient Characterization in COPD: Reasons to Go Beyond GOLD Classification

Tewe L Verhage, Yvonne F Heijdra, Johan Molema, Leonie Daudey, P.N Richard Dekhuijzen, Jan H Vercoulen*
Departments of Pulmonary Diseases and Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

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© Verhage et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Departments of Medical Psychology and Pulmonary Diseases, Radboud University Nijmegen Medical Centre, 6561 KE Groesbeek, The Netherlands; Tel: 00 31 24 6859554; Fax: 00 31 24 6859290; E-mail:


The Global Initiative for Chronic Obstructive Lung Disease (GOLD) serves as a guide to treat and manage different severity classes of patients with COPD. It was suggested that the five categories of FEV1 % predicted (GOLD 0–4), can be applied for selecting different therapeutic approaches. However, validation of these selective properties is very poor. To determine the relevance of the GOLD staging system for estimating the severity of clinical problems, GOLD 2 (n=70) and GOLD 3 (n=65) patients were drawn from a prospective cohort of patients with COPD and evaluated crosssectionally by a newly developed Nijmegen Integral Assessment Framework (NIAF). The NIAF is a detailed assessment of a wide range of aspects of health status (HS). Significant, though small, differences were found in Static Lung Volumes, Exercise Capacity, Subjective Pulmonary Complaints, Subjective Impairment, and Health-Related QoL, besides Airflow of course. Moreover, overlap between scores of these five HS sub-domains was substantial, indicating small clinical relevance for discernment. No significant differences were found in nine other aspects of HS. It is concluded that GOLD stages do not discriminate in any aspect of HS other than airflow obstruction, and therefore do not help the clinician in deciding which treatment modalities are appropriate.