The Relationship Between GOLD Risk Group and Clinical Outcomes in a Community-based COPD Cohort

This study is designed to collect information on the current level of symptoms and ability to
breathe, treatment and outcomes of patients with 1) Chronic Obstructive Pulmonary Disease
(COPD), or 2) in current or former smokers with respiratory symptoms but preserved pulmonary
function or 3) in current or former smokers with respiratory symptoms and preserved ratio
with impaired spirometry. This information will be used by the researchers to better
understand the impact of COPD on patients. It will also help the researchers study the
current recommendations for treatment of COPD.

Chronic obstructive pulmonary disease (COPD) represents a growing public health problem and
is now the third leading cause of death in the United States. The risk of exacerbations,
hospitalizations and death in patients with COPD tends to increase with increasing severity
of airflow limitation. However, the correlation between forced expiratory volume in 1 second
(FEV1), symptoms, and health-related quality of life is weak. The shortcomings of using
airflow limitation alone to assess the clinical severity of COPD led the Global Initiative
for Chronic Obstructive Lung Disease (GOLD) committee to develop a potentially more
clinically meaningful approach to assess the impact of COPD on the patient. The GOLD
committee has subsequently proposed a model for pharmacologic therapy of patients with stable
COPD (i.e. those not currently experiencing a COPD exacerbation) according to GOLD risk
group. The therapeutic recommendations proposed by GOLD are widely cited as a strategy for
selecting therapy even though this model is predominantly based on expert opinion.

This study will acquire data in a community-based cohort in which patients with COPD or
current or former smokers with respiratory symptoms will be classified into GOLD risk groups
A-D at enrollment and followed longitudinally. This study will assess the frequency of change
in GOLD risk group during 5 years of follow-up, look at the use of COPD medications this
cohort and how provider-selected therapy for COPD compares to GOLD-recommended pharmacologic
therapy thus addressing a critical knowledge gap in the scientific community.

Inclusion Criteria:

- Subjects must have the ability to understand and sign a written informed consent form,
which must be obtained prior to initiation of data collection

- Subjects must be ≥40 years of age

- Subjects must have a greater than or equal to 10 pack-year history of tobacco exposure

- Subjects must have:

1. COPD confirmed by spirometry performed at screening (as demonstrated by FEV1/FVC
< 0.70) or

2. If the FEV1/FVC is ≥ 0.7, the subject must be a symptomatic current or past
Smoker with Respiratory Symptoms (SRS) as defined by meeting the following
spirometry and respiratory symptom criteria at screening: FVC ≥ 80% of predicted
and CAT score ≥ 10 or

3. Preserved Ratio Impaired Spirometry (PRISm), defined as a reduced

FEV1 in the setting of a preserved FEV1/FVC ratio:

FEV1/FVC ≥ 0.7 AND FEV1 < 80% of predicted

Exclusion Criteria:

- Participation in an investigational drug trial at the time of screening

- Subjects listed for lung transplantation at the time of screening