Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

Dionne E. Smid; Frits M. E. Franssen; Maria Gonik; Marc Miravitlles; Ciro Casanova; Borja G. Cosio; Pilar de Lucas-Ramos; Jose M. Marin; Cristina Martinez; Isabel Mir; Joan B. Soriano; Juan P. de Torres; Alvar Agusti; Nart B. Atalay; Julia Billington; Afroditi K. Boutou; Stefanie Brighenti-Zogg; Emma Chaplin; Samantha Coster; James W. Dodd; Selina Durr; Alberto Fernandez-Villar; Miriam T. J. Groenen; Miguel Guimaraes; Karel Hejduk; Victoria Higgins; Nicholas S. Hopkinson; Nobuyuki Horita; Sarah Houben-Wilke; Daisy J. A. Janssen; Melissa Jehn; Rudolf Joerres; Annika Karch; Julia L. Kelly; Yu-Il Kim; Hiroshi Kimura; Vladimir Koblizek; Janwillem H. Kocks; Samantha S. C. Kon; Namhee Kwon; Ines Ladeira; Sang-Do Lee; Joerg D. Leuppi; Nicholas Locantore; Jose L. Lopez-Campos; William D-C Man; Lana Maricic; Laura Mendoza; David Miedinger; Florin Mihaltan; Seigo Minami; Thys van der Molen; Trevor J. Murrells; Nienke Nakken; Yu Nishijima; Ian J. Norman; Barbora Novotna; Denis E. O'Donnell; Yoshitaka Ogata; Eanes D. Pereira; James Piercy; David Price; Chaicharn Pothirat; Natya Raghavan; Thomas Ringbaek; Dimitar Sajkov; Naseh Sigari; Sally Singh; Mark Small; Guilherme F. da Silva; Rebecca J. Tanner; Ioanna G. Tsiligianni; Baykal Tulek; Nikolaos Tzanakis; Lowie E. G. W. Vanfleteren; Henrik Watz; Katherine A. Webb; Emiel F. M. Wouters; Guogang G. Xie; Masanori Yoshikawa; Martijn A. Spruit

doi:10.1016/j.jamda.2017.09.003

Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

Dionne E. Smid^*, Frits M. E. Franssen, Maria Gonik, Marc Miravitlles, Ciro Casanova, Borja G. Cosio, Pilar de Lucas-Ramos, Jose M. Marin, Cristina Martinez, Isabel Mir, Joan B. Soriano, Juan P. de Torres, Alvar Agusti, Nart B. Atalay, Julia Billington, Afroditi K. Boutou, Stefanie Brighenti-Zogg, Emma Chaplin, Samantha Coster, James W. DoddSelina Durr, Alberto Fernandez-Villar, Miriam T. J. Groenen, Miguel Guimaraes, Karel Hejduk, Victoria Higgins, Nicholas S. Hopkinson, Nobuyuki Horita, Sarah Houben-Wilke, Daisy J. A. Janssen, Melissa Jehn, Rudolf Joerres, Annika Karch, Julia L. Kelly, Yu-Il Kim, Hiroshi Kimura, Vladimir Koblizek, Janwillem H. Kocks, Samantha S. C. Kon, Namhee Kwon, Ines Ladeira, Sang-Do Lee, Joerg D. Leuppi, Nicholas Locantore, Jose L. Lopez-Campos, William D-C Man, Lana Maricic, Laura Mendoza, David Miedinger, Florin Mihaltan, Seigo Minami, Thys van der Molen, Trevor J. Murrells, Nienke Nakken, Yu Nishijima, Ian J. Norman, Barbora Novotna, Denis E. O'Donnell, Yoshitaka Ogata, Eanes D. Pereira, James Piercy, David Price, Chaicharn Pothirat, Natya Raghavan, Thomas Ringbaek, Dimitar Sajkov, Naseh Sigari, Sally Singh, Mark Small, Guilherme F. da Silva, Rebecca J. Tanner, Ioanna G. Tsiligianni, Baykal Tulek, Nikolaos Tzanakis, Lowie E. G. W. Vanfleteren, Henrik Watz, Katherine A. Webb, Emiel F. M. Wouters, Guogang G. Xie, Masanori Yoshikawa, Martijn A. Spruit

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.

Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.

Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.

Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.

Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Original language	English
Article number	ARTN 1097.e11-1097.e24
Number of pages	14
Journal	Journal of the American Medical Directors Association
Volume	18
Issue number	12
DOIs	https://doi.org/10.1016/j.jamda.2017.09.003
Publication status	Published - 1 Dec 2017

Keywords

COPD
GOLD
health status
clinical significance
COPD ASSESSMENT TEST
QUALITY-OF-LIFE
RESEARCH-COUNCIL SCALE
ASSESSMENT TEST SCORE
HEALTH-STATUS
CLINICAL CHARACTERISTICS
HISTORY ASSESSMENT
PHYSICAL-ACTIVITY
CAT
POPULATION

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Smid, D. E., Franssen, F. M. E., Gonik, M., Miravitlles, M., Casanova, C., Cosio, B. G., de Lucas-Ramos, P., Marin, J. M., Martinez, C., Mir, I., Soriano, J. B., de Torres, J. P., Agusti, A., Atalay, N. B., Billington, J., Boutou, A. K., Brighenti-Zogg, S., Chaplin, E., Coster, S., ... Spruit, M. A. (2017). Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease. Journal of the American Medical Directors Association, 18(12), Article ARTN 1097.e11-1097.e24. https://doi.org/10.1016/j.jamda.2017.09.003

@article{11cd5d1e3a6f46bfa713eec3592c23ed,

title = "Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease",

abstract = "Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.",

keywords = "COPD, GOLD, health status, clinical significance, COPD ASSESSMENT TEST, QUALITY-OF-LIFE, RESEARCH-COUNCIL SCALE, ASSESSMENT TEST SCORE, HEALTH-STATUS, CLINICAL CHARACTERISTICS, HISTORY ASSESSMENT, PHYSICAL-ACTIVITY, CAT, POPULATION",

author = "Smid, {Dionne E.} and Franssen, {Frits M. E.} and Maria Gonik and Marc Miravitlles and Ciro Casanova and Cosio, {Borja G.} and {de Lucas-Ramos}, Pilar and Marin, {Jose M.} and Cristina Martinez and Isabel Mir and Soriano, {Joan B.} and {de Torres}, {Juan P.} and Alvar Agusti and Atalay, {Nart B.} and Julia Billington and Boutou, {Afroditi K.} and Stefanie Brighenti-Zogg and Emma Chaplin and Samantha Coster and Dodd, {James W.} and Selina Durr and Alberto Fernandez-Villar and Groenen, {Miriam T. J.} and Miguel Guimaraes and Karel Hejduk and Victoria Higgins and Hopkinson, {Nicholas S.} and Nobuyuki Horita and Sarah Houben-Wilke and Janssen, {Daisy J. A.} and Melissa Jehn and Rudolf Joerres and Annika Karch and Kelly, {Julia L.} and Yu-Il Kim and Hiroshi Kimura and Vladimir Koblizek and Kocks, {Janwillem H.} and Kon, {Samantha S. C.} and Namhee Kwon and Ines Ladeira and Sang-Do Lee and Leuppi, {Joerg D.} and Nicholas Locantore and Lopez-Campos, {Jose L.} and Man, {William D-C} and Lana Maricic and Laura Mendoza and David Miedinger and Florin Mihaltan and Seigo Minami and {van der Molen}, Thys and Murrells, {Trevor J.} and Nienke Nakken and Yu Nishijima and Norman, {Ian J.} and Barbora Novotna and O'Donnell, {Denis E.} and Yoshitaka Ogata and Pereira, {Eanes D.} and James Piercy and David Price and Chaicharn Pothirat and Natya Raghavan and Thomas Ringbaek and Dimitar Sajkov and Naseh Sigari and Sally Singh and Mark Small and {da Silva}, {Guilherme F.} and Tanner, {Rebecca J.} and Tsiligianni, {Ioanna G.} and Baykal Tulek and Nikolaos Tzanakis and Vanfleteren, {Lowie E. G. W.} and Henrik Watz and Webb, {Katherine A.} and Wouters, {Emiel F. M.} and Xie, {Guogang G.} and Masanori Yoshikawa and Spruit, {Martijn A.}",

year = "2017",

month = dec,

day = "1",

doi = "10.1016/j.jamda.2017.09.003",

language = "English",

volume = "18",

journal = "Journal of the American Medical Directors Association",

issn = "1525-8610",

publisher = "Elsevier Inc.",

number = "12",

}

Smid, DE, Franssen, FME, Gonik, M, Miravitlles, M, Casanova, C, Cosio, BG, de Lucas-Ramos, P, Marin, JM, Martinez, C, Mir, I, Soriano, JB, de Torres, JP, Agusti, A, Atalay, NB, Billington, J, Boutou, AK, Brighenti-Zogg, S, Chaplin, E, Coster, S, Dodd, JW, Durr, S, Fernandez-Villar, A, Groenen, MTJ, Guimaraes, M, Hejduk, K, Higgins, V, Hopkinson, NS, Horita, N, Houben-Wilke, S, Janssen, DJA, Jehn, M, Joerres, R, Karch, A, Kelly, JL, Kim, Y-I, Kimura, H, Koblizek, V, Kocks, JH, Kon, SSC, Kwon, N, Ladeira, I, Lee, S-D, Leuppi, JD, Locantore, N, Lopez-Campos, JL, Man, WD-C, Maricic, L, Mendoza, L, Miedinger, D, Mihaltan, F, Minami, S, van der Molen, T, Murrells, TJ, Nakken, N, Nishijima, Y, Norman, IJ, Novotna, B, O'Donnell, DE, Ogata, Y, Pereira, ED, Piercy, J, Price, D, Pothirat, C, Raghavan, N, Ringbaek, T, Sajkov, D, Sigari, N, Singh, S, Small, M, da Silva, GF, Tanner, RJ, Tsiligianni, IG, Tulek, B, Tzanakis, N, Vanfleteren, LEGW, Watz, H, Webb, KA, Wouters, EFM, Xie, GG, Yoshikawa, M & Spruit, MA 2017, 'Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease', Journal of the American Medical Directors Association, vol. 18, no. 12, ARTN 1097.e11-1097.e24. https://doi.org/10.1016/j.jamda.2017.09.003

Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease. / Smid, Dionne E.; Franssen, Frits M. E.; Gonik, Maria et al.
In: Journal of the American Medical Directors Association, Vol. 18, No. 12, ARTN 1097.e11-1097.e24, 01.12.2017.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

AU - Smid, Dionne E.

AU - Franssen, Frits M. E.

AU - Gonik, Maria

AU - Miravitlles, Marc

AU - Casanova, Ciro

AU - Cosio, Borja G.

AU - de Lucas-Ramos, Pilar

AU - Marin, Jose M.

AU - Martinez, Cristina

AU - Mir, Isabel

AU - Soriano, Joan B.

AU - de Torres, Juan P.

AU - Agusti, Alvar

AU - Atalay, Nart B.

AU - Billington, Julia

AU - Boutou, Afroditi K.

AU - Brighenti-Zogg, Stefanie

AU - Chaplin, Emma

AU - Coster, Samantha

AU - Dodd, James W.

AU - Durr, Selina

AU - Fernandez-Villar, Alberto

AU - Groenen, Miriam T. J.

AU - Guimaraes, Miguel

AU - Hejduk, Karel

AU - Higgins, Victoria

AU - Hopkinson, Nicholas S.

AU - Horita, Nobuyuki

AU - Houben-Wilke, Sarah

AU - Janssen, Daisy J. A.

AU - Jehn, Melissa

AU - Joerres, Rudolf

AU - Karch, Annika

AU - Kelly, Julia L.

AU - Kim, Yu-Il

AU - Kimura, Hiroshi

AU - Koblizek, Vladimir

AU - Kocks, Janwillem H.

AU - Kon, Samantha S. C.

AU - Kwon, Namhee

AU - Ladeira, Ines

AU - Lee, Sang-Do

AU - Leuppi, Joerg D.

AU - Locantore, Nicholas

AU - Lopez-Campos, Jose L.

AU - Man, William D-C

AU - Maricic, Lana

AU - Mendoza, Laura

AU - Miedinger, David

AU - Mihaltan, Florin

AU - Minami, Seigo

AU - van der Molen, Thys

AU - Murrells, Trevor J.

AU - Nakken, Nienke

AU - Nishijima, Yu

AU - Norman, Ian J.

AU - Novotna, Barbora

AU - O'Donnell, Denis E.

AU - Ogata, Yoshitaka

AU - Pereira, Eanes D.

AU - Piercy, James

AU - Price, David

AU - Pothirat, Chaicharn

AU - Raghavan, Natya

AU - Ringbaek, Thomas

AU - Sajkov, Dimitar

AU - Sigari, Naseh

AU - Singh, Sally

AU - Small, Mark

AU - da Silva, Guilherme F.

AU - Tanner, Rebecca J.

AU - Tsiligianni, Ioanna G.

AU - Tulek, Baykal

AU - Tzanakis, Nikolaos

AU - Vanfleteren, Lowie E. G. W.

AU - Watz, Henrik

AU - Webb, Katherine A.

AU - Wouters, Emiel F. M.

AU - Xie, Guogang G.

AU - Yoshikawa, Masanori

AU - Spruit, Martijn A.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

AB - Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores.Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points.Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points.Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

KW - COPD

KW - GOLD

KW - health status

KW - clinical significance

KW - COPD ASSESSMENT TEST

KW - QUALITY-OF-LIFE

KW - RESEARCH-COUNCIL SCALE

KW - ASSESSMENT TEST SCORE

KW - HEALTH-STATUS

KW - CLINICAL CHARACTERISTICS

KW - HISTORY ASSESSMENT

KW - PHYSICAL-ACTIVITY

KW - CAT

KW - POPULATION

U2 - 10.1016/j.jamda.2017.09.003

DO - 10.1016/j.jamda.2017.09.003

M3 - Article

SN - 1525-8610

VL - 18

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

IS - 12

M1 - ARTN 1097.e11-1097.e24

ER -

Smid DE, Franssen FME, Gonik M, Miravitlles M, Casanova C, Cosio BG et al. Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease. Journal of the American Medical Directors Association. 2017 Dec 1;18(12):ARTN 1097.e11-1097.e24. doi: 10.1016/j.jamda.2017.09.003

Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

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Keywords

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