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

• Authors: SMID D.E.; FRANSSEN F.M.E.; GONIK M.; MIRAVITLLES M.; CASANOVA C.; COSIO B.G.; LUCAS-RAMOS P. de; MARIN J.M.; MARTINEZ C.; MIR I.; SORIANO J.B.; TORRES J.P. de; AGUSTI A.; ATALAY N.B.; BILLINGTON J.; BOUTOU A.K.; BRIGHENTI-ZOGG S.; CHAPLIN E.; COSTER S.; DODD J.W.; DURR S.; FERNANDEZ-VILLAR A.; GROENEN M.T.J.; GUIMARAES M.; HEJDUK Karel; HIGGINS V.; HOPKINSON N.S.; HORITA N.; HOUBEN-WILKE S.; JANSSEN D.J.A.; JEHN M.; JOERRES R.; KARCH A.; KELLY J.L.; KIM Y.I.; KIMURA H.; KOBLIZEK V.; KOCKS J.H.; KON S.S.C.; KWON N.; LADEIRA I.; LEE S.D.; LEUPPI J.D.; LOCANTORE N.; LOPEZ-CAMPOS J.L.; MAN W.D.C.; MARICIC L.; MENDOZA L.; MIEDINGER D.; MIHALTAN F.; MINAMI S.; MOLEN T. van der; MURRELLS T.J.; NAKKEN N.; NISHIJIMA Y.; NORMAN I.J.; NOVOTNA B.; O DONNELL D.E.; OGATA Y.; PEREIRA E.D.; PIERCY J.; PRICE D.; POTHIRAT C.; RAGHAVAN N.; RINGBAEK T.; SAJKOV D.; SIGARI N.; SINGH S.; SMALL M.; DA SILVA G.F.; TANNER R.J.; TSILIGIANNI I.G.; TULEK B.; TZANAKIS N.; VANFLETEREN L.E.G.W.; WATZ H.; WEBB K.A.; WOUTERS E.F.M.; XIE G.G.; YOSHIKAWA M.; SPRUIT M.A.
• Year of publication: 2017
• Type: Article in Periodical
• Magazine / Source: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
• MU Faculty or unit: Faculty of Medicine
• Doi: http://dx.doi.org/10.1016/j.jamda.2017.09.003
• Field: Other medical specializations
• Keywords: COPD; GOLD; health status; clinical significance
• Description: 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.