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; Miravitlles, Marc; Casanova, Ciro; Cosio, Borja G.; de Lucas-Ramos, Pilar; Marin, Jose M.; Martinez, Cristina; Mir, Isabel; Soriano, Joan B.; de Torres, Juan P.; Agusti, Alvar; Atalay, Nart Bedin; Billington, Julia; Boutou, Afroditi K.; Brighenti-Zogg, Stefanie; Chaplin, Emma; Coster, Samantha; Dodd, James W.; Durr, Selina; Fernandez-Villar, Alberto; Groenen, Miriam T. J.; Guimaraes, Miguel; Hejduk, Karel; Higgins, Victoria; Hopkinson, Nicholas S.; Horita, Nobuyuki; Houben-Wilke, Sarah; Janssen, Daisy J. A.; Jehn, Melissa; Joerres, Rudolf; Karch, Annika; Kelly, Julia L.; Kim, Yu-Il; Kimura, Hiroshi; Koblizek, Vladimir; Kocks, Janwillem H.; Kon, Samantha S. C.; Kwon, Namhee; Ladeira, Ines; Lee, Sang-Do; Leuppi, Joerg D.; Locantore, Nicholas; Lopez-Campos, Jose L.; Man, William D-C; Maricic, Lana; Mendoza, Laura; Miedinger, David; Mihaltan, Florin; Minami, Seigo; van der Molen, Thys; Murrells, Trevor J.; Nakken, Nienke; Nishijima, Yu; Norman, Ian J.; Novotna, Barbora; O'Donnell, Denis E.; Ogata, Yoshitaka; Pereira, Eanes D.; Piercy, James; Price, David; Pothirat, Chaicharn; Raghavan, Natya; Ringbaek, Thomas; Sajkov, Dimitar; Sigari, Naseh; Singh, Sally; Small, Mark; da Silva, Guilherme F.; Tanner, Rebecca J.; Tsiligianni, Ioanna G.; Tulek, Baykal; Tzanakis, Nikolaos; Vanfleteren, Lowie E. G. W.; Watz, Henrik; Webb, Katherine A.; Wouters, Emiel F. M.; Xie, Guogang G.; Yoshikawa, Masanori; Spruit, Martijn A.
Date:
2017-12-01
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.
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