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
Language English Country United States Media print
Document type Journal Article, Review
Grant support
CTF-01-12-04
Department of Health - United Kingdom
DHCS/07/07/009
Department of Health - United Kingdom
G0701628
Medical Research Council - United Kingdom
G1002113
Medical Research Council - United Kingdom
PB-PG-0213-30003
Department of Health - United Kingdom
PubMed
29169740
DOI
10.1016/j.jamda.2017.09.003
PII: S1525-8610(17)30515-7
Knihovny.cz E-resources
- Keywords
- COPD, GOLD, clinical significance, health status,
- MeSH
- Global Health MeSH
- Pulmonary Disease, Chronic Obstructive classification diagnosis therapy MeSH
- Risk Assessment MeSH
- Middle Aged MeSH
- Humans MeSH
- Evidence-Based Medicine MeSH
- Disease Progression * MeSH
- Aged MeSH
- Sex Factors MeSH
- Practice Guidelines as Topic * MeSH
- Severity of Illness Index MeSH
- Sickness Impact Profile MeSH
- Symptom Assessment methods MeSH
- Age Factors MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
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, postbronchodilator 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.
2nd Department of Internal Medicine Nara Medical University Nara Japan
Adelphi Real World Bollington United Kingdom
Arbeitsbereich Ambulante Pneumologie Charité Universitätsmedizin Berlin Berlin Germany
Australian Respiratory and Sleep Medicine Institute Flinders Medical Center Adelaide Australia
Biomax Informatics AG Planegg Germany
Central Surgery Surbiton Health Centre Surbiton Surrey United Kingdom
Department of Chest Diseases Faculty of Medicine Selcuk University Konya Turkey
Department of Medicine McMaster University Hamilton Ontario Canada
Department of Medicine Queen's University and Kingston General Hospital Kingston ON Canada
Department of Psychology TOBB University of Economics and Technology Ankara Turkey
Department of Pulmonology Yokohama City University Graduate School of Medicine Yokohama Japan
Department of Research and Education CIRO Horn The Netherlands
Department of Respiratory Medicine Hospital Son Espases IdISPa CIBERES Islas Baleares Spain
Department of Respiratory Medicine Hvidovre Hospital University of Copenhagen Denmark
Department of Respiratory Medicine Osaka Police Hospital Osaka Japan
Federal University of Ceará Brazil Fortaleza Brazil
GlaxoSmithKline King of Prussia PA
Hospital Clínico Universidad de Chile Región Metropolitana Chile
Hospital General Universitario Gregorio Marañón Madrid Pulmonary Department Madrid Spain
Hospital General Universitario Gregorio Marañon Pulmonary Department Madrid Spain
Hospital Universitario Miguel Servet IISAragon CIBER Enfermedades Respiratorias Zaragoza Spain
Institute and Output Clinic for Occupational and Environmental Medicine Munich Germany
Institute for Biostatistics Hannover Medical School Hannover Germany
Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic
Institute of Pneumology Marius Nasta Bucharest Romania
Internal Medicine Department Medical Faculty Kurdistan University of Medical Sciences Sanandaj Iran
King's College London Florence Nightingale Faculty of Nursing and Midwifery London United Kingdom
Pulmonary Department Clinica Universidad de Navarra Pamplona Spain
Pulmonology Department of Centro Hospitalar Vila Nova de Gaia Espinho EPE Portugal
Respiratory Franchise Medical GlaxoSmithKline London United Kingdom
Respiratory Institute Hospital Clinic University of Barcelona and CIBERES Spain
University Clinic of Medicine Cantonal Hospital Baselland Liestal Switzerland
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