People who have chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), have difficulty in breathing, shortness of breath, wheezing, chest tightness, and other respiratory symptoms that get worse over time. COPD is a significant cause of death, and the World Health Organization (WHO) estimates that approximately three million deaths were caused by the disease in 2015, making the disease responsible for 5% of all deaths globally that year. Understanding a patient’s disease severity is important in the management of COPD. Several classification systems are in use for COPD, which can result in significantly different patient characteristics depending on which system is used.

GlobalData epidemiologists conducted a patient-based epidemiological forecast for COPD for the eight major markets (8MM: US, France, Germany, Italy, Spain, UK, Japan, and Australia), including an in-depth analysis of patient segmentation by severity. Severity level for COPD patients is commonly determined by spirometry test results, which measure how deeply a person breathes and how fast air moves in and out of the lungs. The current, most relevant severity criteria is the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 standard, which considers current symptoms and future exacerbation risk by grouping patients into four groups—Group A: low risk, less symptoms; Group B: low risk, more symptoms; Group C: high risk, less symptoms; Group D: high risk, more symptoms. Two tests are used for defining the severity stages of COPD in the new GOLD 2011 system: modified Medical Research Council (mMRC) dyspnea scores and COPD Assessment Test (CAT) scores. GlobalData epidemiologists found that when using mMRC scores to measure severity, the majority of cases in the 8MM are in Group A, indicating low risk and less symptoms. However, when using CAT scores to measure severity, the majority of cases are in Group B, indicating low risk and more symptoms.

Figure 1 presents the distribution of GOLD severity groups by the two severity scoring systems in COPD patients in the 8MM. When using the mMRC system, 31.16% of diagnosed prevalent cases of COPD were in Group A, compared to only 8.01% in Group A when using the CAT system. The CAT system also resulted in a much higher proportion of the most severe group, Group D, compared to the mMRC system. Physicians treating COPD need to be aware of how a patient may be categorized differently depending on the criteria being used.

Figure 1: 8MM, COPD Severity Distribution for mMRC and CAT GOLD Score Systems, by Group

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