Prognostic risk profiling in COPD using Global Initiative for Chronic Obstructive Lung Disease 2023 ABE and comorbidity assessment: evidence from a register-based COPD cohort PDF Free Download
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Electronic supplementary material:
The online version of this article contains supplementary material.
Cite as: Lin CH, Li YR, Cheng SL, Wang HC, Lin HI, Lee KY, Chong IW, Chan PC, Chen HW, Yu CJ. Prog-
nostic risk profiling in COPD using Global Initiative for Chronic Obstructive Lung Disease 2023 ABE
and comorbidity assessment: evidence from a register-based COPD. J Glob Health. 2025;15:04152.
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Correspondence to:
© 2025 The Author(s)
Background While the Global Initiative for Chronic Obstructive
Lung Disease (GOLD) 2023 ABE classification system guides ini-
tial chronic obstructive pulmonary disease (COPD) treatment,
patient heterogeneity and comorbidities complicate manage-
ment. We investigated how the GOLD 2023 ABE classification
and aligned comorbidity profiles affect patient outcomes in re-
al-world Asian populations with COPD.
Methods We conducted a register-based cohort study of 38 928
patients from multiple institutions across Taiwan (from April
2017 to December 2021). We classified patients by GOLD 2023
ABE categories. Data included demographics, Charlson comor-
bidity index (CCI)-defined comorbidities, treatment, symp-
toms, questionnaires, spirometry, and outcomes.
Results Among COPD patients, 89.2% were males, and the medi-
an age was 71 years. Groups A comprised 30.2%, group B 46.4%,
and group E 23.5% of patients. Among these, 28.3% of group A
patients used inhaled corticosteroid-containing inhalers. Group
E had the highest rates of GOLD 4 airway obstruction (11.8%),
CCI score ≥4 (15.6%), and five-year mortality rate (22.6%).
Group E demonstrated the highest risk of all-cause mortality
(hazard ratio (HR) = 1.727; 95% confidence interval (CI) = 1.605–
1.858) and moderate-to-severe exacerbation (HR = 2.127; 95%
CI = 1.942–2.330) vs. group A. Key comorbidities, acute myo-
cardial infarction (HR = 1.257; 95% CI = 1.057–1.430), conges-
tive heart failure (HR = 1.836; 95% CI = 1.707–1.909), and pulmo-
nary disease (HR = 1.071; 95% CI = 1.011–1.129), were associated
with higher mortality. Acute myocardial infarction (HR = 1.251;
95% CI = 1.031–1.444), congestive heart failure (HR = 1.193; 95%
CI = 1.089–1.285), and pulmonary disease (HR = 1.491; 95%
CI = 1.405–1.550) were also associated with higher exacerbations,
with patterns varying across GOLD groups.
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Conclusions In this large registry-based cohort, group E patients demonstrated the highest mortality
and exacerbation risks. Cardiovascular and pulmonary comorbidities increased adverse outcome risks
across all GOLD categories. Systematic comorbidity screening should be integrated into routine COPD
care. Findings support personalised treatment approaches based on GOLD classification and comor-
bidity profiles.
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Online Supplementary Document
Table 1
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Table 1.
Demographics All patients (n = 38 928) Group A (n = 11 741) Group B (n = 18 056) Group E (n = 9131) P-value
≤50
51–60
61–70
71–80
>80
<18.5
18.5–24
≥24
Never
Former
Current
Yes
No
Post-BD FEV1, L
Post-BD FEV1, % predicted
Post-BD FEV1/FVC, %
<2
≥2
1–10
11–20
21–30
31–40
Yes
No
0
1–3
≥4
<2
≥2
I
II
III
IV
None
ICS
LABA
LAMA
LABA + ICS or LABA/ICS
LABA + LAMA or LABA/LAMA
Triple†
Prognosc proling in COPD: GOLD 2023 ABE and comorbidity analysis
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Figure 1
Figure 1
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Figure 2
Online Supplementary Document
Demographics All patients (n = 38 928) Group A (n = 11 741) Group B (n = 18 056) Group E (n = 9131) P-value
Yes
No
Table 1.
Figure 1.Panel A.
Panel B.Panel C.
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Figure 3
Figure 3
Figure 3
Online Supplementary Document
Online Supplementary Document
Online Supplementary Document
Figure 2.Panel A.
Panel B.Panel C.
Prognosc proling in COPD: GOLD 2023 ABE and comorbidity analysis
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Figure 3
Online Supplementary Document
Figure 3.
Panel A.
Panel B.
Panel C.
Panel D.
Panel E.
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Acknowledgements:
Ethics statement:
Data availability:
Funding:
Authorship contributions:
Disclosure of interest:
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Prognosc proling in COPD: GOLD 2023 ABE and comorbidity analysis
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