212 2014 Updated GOLD Scenarios journal.copdfoundation.org JCOPDF © 2014 Volume 1 • Number 2 • 2014 For personal use only. Permission required for all other uses. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Original Research The 2014 Updated GOLD Strategy: A Comparison of the Various Scenarios Sarah Wilke, MSc,* 1 Dionne E. Smid, MSc,* 1 Martijn A. Spruit, PhD, 1 Daisy J. A. Janssen, MD, PhD, 1,2 Jean W. M. Muris, MD, PhD, 3 Thys van der Molen, MD, PhD, 4 Marjan van den Akker, PhD, 3,5 Paul W. Jones, MD, PhD, 6 Emiel F.M. Wouters, MD, PhD, 1,7 and Frits M.E. Franssen, MD, PhD 1 * Joint first author Background: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George’s Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the diferent deinitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown. Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV 1 54.7 [22.3]% predicted). Health status was assessed by the COPD-speciic SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen’s Kappa was used to assess agreement between groups. Results: Level of agreement in frequency distribution using the modiied Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (K = 0.838 or 0.851, p<0.001). Patients classiied in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classiied in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups. Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used. Abbreviations: Global initiative for chronic Obstructive Lung Disease, GOLD; St. George’s Respiratory Questionnaire, SGRQ; Hospital Anxiety and Depression Scale, anxiety subscale, HADS-A; Hospital Anxiety and Depression Scale, depression subscale, HADS-D; COPD Assessment Test, CAT; Clinical COPD Questionnaire, CCQ; modiied Medical Research Council dyspnea scale, mMRC; body mass index, BMI; forced expiratory volume in 1 second, FEV 1 ; forced vital capacity, FVC; Timed Up and Go test, TUG test; COPD-speciic version of St. George’s Respiratory Questionaire, SGRQ-C; least signiicance diference, LSD. Funding Support: This study was inancially supported by the Lung Foundation Netherlands (3.4.10.015 ) and GlaxoSmithKline (SCO115406 ). Date of Acceptance: July 9, 2014 Citation: Wilke S, Smid DE, Spruit MA, et al. The 2014 updated GOLD strategy: A comparison of the various scenarios. J COPD F. 2014; 212-220. doi: http://dx.doi.org/10.15326/jcopdf.1.2.2014.0135 Abstract 1 Department of Research & Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands 2 Centre of Expertise for Palliative Care, Maastricht University Medical Centre, the Netherlands This article has an online supplement. 3 Caphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands 4 Department of General Practice, University of Groningen, University Medical Centre Groningen, the Netherlands 5 Department of General Practice, KU Leuven, Leuven, Belgium 6 Division of Clinical Science, St. George’s University of London, United Kingdom 7 Department of Respiratory Medicine, Maastricht University Medical Centre, the Netherlands