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 -