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1. Clinical and Prognostic Impact of Low Diffusing Capacity for Carbon Monoxide Values in Patients With Global Initiative for Obstructive Lung Disease I COPD.

Author

de-Torres JP, O'Donnell DE, Marín JM, Cabrera C, Casanova C, Marín M, Ezponda A, Cosio BG, Martinez C, Solanes I, Fuster A, Neder JA, Gonzalez-Gutierrez J, and Celli BR

Subjects
Body Mass Index, Canada epidemiology, Female, Humans, Male, Middle Aged, Mortality, Patient Acuity, Predictive Value of Tests, Prognosis, Risk Assessment methods, Smoking epidemiology, Spain epidemiology, Walk Test methods, Carbon Monoxide analysis, Exercise Tolerance, Pulmonary Diffusing Capacity, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive mortality, Pulmonary Disease, Chronic Obstructive physiopathology, Spirometry methods, Spirometry statistics & numerical data
Abstract

Background: The Global Initiative for Obstructive Lung Disease (GOLD) does not promote diffusing capacity for carbon monoxide (Dlco) values in the evaluation of COPD. In GOLD spirometric stage I COPD patients, the clinical and prognostic impact of a low Dlco has not been explored., Research Question: Could a Dlco threshold help define an increased risk of death and a different clinical presentation in these patients?, Study Design and Methods: GOLD stage I COPD patients (n = 360) were enrolled and followed over 109 ± 50 months. Age, sex, pack-years' history, BMI, dyspnea, lung function measurements, exercise capacity, BODE index, and history of exacerbations were recorded. A cutoff value for Dlco was identified for all-cause mortality and the clinical and physiological characteristics of patients above and below the threshold compared. Cox regression analysis explored the predictive power of that cutoff value for all-cause mortality., Results: A Dlco cutoff value of <60% predicted was associated with all-cause mortality (Dlco ≥ 60%: 9% vs Dlco < 60%: 23%, P = .01). At a same FEV 1 % predicted and Charlson score, patients with Dlco < 60% had lower BMI, more dyspnea, lower inspiratory capacity (IC)/total lung capacity (TLC) ratio, lower 6-min walk distance (6MWD), and higher BODE. Cox multiple regression analysis confirmed that after adjusting for age, sex, pack-years history, smoking status, and BMI, a Dlco < 60% is associated with all-cause mortality (hazard ratio [HR], 95% CI = 3.37, 1.35-8.39; P = .009) INTERPRETATION: In GOLD I COPD patients, a Dlco < 60% predicted is associated with increased risk of death and worse clinical presentation. What the cause(s) of this association are and whether they can be treated need to be determined., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Published
2021
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2. Longitudinal assessment in COPD patients: multidimensional variability and outcomes.

Author

Casanova C, Aguirre-Jaíme A, de Torres JP, Pinto-Plata V, Baz R, Marin JM, Divo M, Cordoba E, Basaldua S, Cote C, and Celli BR

Subjects
Aged, Algorithms, Body Mass Index, Disease Progression, Dyspnea physiopathology, Exercise Tolerance, Female, Humans, Longitudinal Studies, Male, Middle Aged, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive mortality, Reproducibility of Results, Respiratory Function Tests, Risk, Severity of Illness Index, Time Factors, Treatment Outcome, Forced Expiratory Volume, Pulmonary Disease, Chronic Obstructive physiopathology, Spirometry methods
Abstract

The value and timing of multidimensional assessments in chronic obstructive pulmonary disease (COPD) remains unclear because there is little information about their variability and relationship to outcome. The aim of this study was to determine the progression of COPD using clinical and spirometric variability over time with mortality as the outcome. We determined the annual intra-individual variability of forced expiratory volume in 1 s (FEV1) and BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity) index in 403 patients with at least five measurements. The pattern was defined as "stable" if the annual change remained constant in ≥66% of the observations and "unstable" if it did not meet that threshold. We explored the minimum number of yearly observations that related to mortality in the 704 patients of the cohort. The "unstable" pattern of FEV1 was seen in 53% and 40% of patients using a threshold of 40 mL·year(-1) and 100 mL·year(-1), respectively. There was a slightly more "stable" pattern in the BODE index (62% for 1 point). A profile associated with mortality was defined by a baseline measurement followed by annual measurements for 2 years of the BODE index, but not its individual components, including FEV1 (p<0.001). Progression of COPD measured using FEV1 is inconsistent and relates poorly to outcome. Monitoring the more stable BODE index better assesses disease progression.

Published
2014
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3. Prognostic assessment in COPD: health related quality of life and the BODE index.

Author

Marin JM, Cote CG, Diaz O, Lisboa C, Casanova C, Lopez MV, Carrizo SJ, Pinto-Plata V, Dordelly LJ, Nekach H, and Celli BR

Subjects
Aged, Analysis of Variance, Cohort Studies, Female, Health Status Indicators, Humans, Male, Prognosis, Pulmonary Disease, Chronic Obstructive mortality, Pulmonary Disease, Chronic Obstructive psychology, Quality of Life psychology, Severity of Illness Index, Surveys and Questionnaires, Pulmonary Disease, Chronic Obstructive physiopathology, Spirometry methods
Abstract

Rationale: COPD is a debilitating disease with increasing mortality worldwide. The BODE index evaluates disease severity and the St George's Respiratory Questionnaire (SGRQ) measures health status., Objective: To identify the relationship between BODE index and the SGRQ and to test the predictive value of both tools against survival., Methods: Open cohort study of 1398 COPD patients (85% male) followed for up to 10 years., Measurements and Main Results: At the time of the inclusion, clinical data, forced spirometry and 6 min walking distance were determined and BODE index and SGRQ were calculated. Vital status and cause of death were documented at the end of follow-up., Results: The cohort's mean of FEV1% predicted was 46 ± 18%, BODE index was 3.6 ± 2.5, and SGRQ% total score was 49 ± 20. The SGRQ scores increased progressively as severity of COPD increased by BODE quartiles. The correlation between SGRQ and BODE index was good (r = 0.58, p < 0.0001). Both tests correlated with COPD survival (BODE = -0.4 vs. SGRQ = -0.20, p < 0.0001). The area under the curve (AUC) for the BODE index was 0.77 vs. 0.66 for the SGRQ % total score (p < 0.001)., Conclusions: Health status as measured by SGRQ worsens with disease severity evaluated by the BODE index. Both tools predict mortality and provide complimentary information in the evaluation of patients with COPD., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Published
2011
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4. Prognostic assessment in COPD without lung function: the B-AE-D indices

Author

Boeck, Lucas, Soriano, Joan B., Brusse-Keizer, Marjolein, Blasi, Francesco, Kostikas, Konstantinos, Boersma, Wim, Milenkovic, Branislava, Louis, Renaud, Lacoma, Alicia, Djamin, Remco, Aerts, Joachim, Torres, Antoni, Rohde, Gernot, Welte, Tobias, Martinez-Camblor, Pablo, Rakic, Janko, Scherr, Andreas, Koller, Michael, van der Palen, Job, Marin, Jose M., Alfageme, Inmaculada, Almagro, Pere, Casanova, Ciro, Esteban, Cristobal, Soler-Cataluña, Juan J., de-Torres, Juan P., Miravitlles, Marc, Celli, Bartolome R., Tamm, Michael, Stolz, Daiana, Universitat Autònoma de Barcelona, Pulmonologie, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, MUMC+: MA Med Staf Spec Longziekten (9), and Faculty of Behavioural, Management and Social Sciences

Subjects
Male, Exacerbation, Severity of Illness Index, Body Mass Index, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Forced Expiratory Volume, 030212 general & internal medicine, Longitudinal Studies, Lung, 2. Zero hunger, COPD, medicine.diagnostic_test, Glycopeptides, Middle Aged, Prognosis, 3. Good health, Respiratory Function Tests, Treatment Outcome, Cardiology, Female, METIS-318027, Risk assessment, Pulmonary and Respiratory Medicine, Spirometry, medicine.medical_specialty, Risk Assessment, External validity, 03 medical and health sciences, Copeptin, Internal medicine, Severity of illness, medicine, Humans, Mortality, Exercise, Aged, Inflammation, business.industry, Reproducibility of Results, medicine.disease, respiratory tract diseases, Oxygen, Dyspnea, 030228 respiratory system, Physical therapy, IR-101435, business, Body mass index
Abstract

Altres ajuts: A. Schötzau performed data management of PROMISE for which he received financial compensation.Thermo Scientific Biomarkers (Hennigsdorf, Germany) provided all the reagents for copeptin measurements. Several composite markers have been proposed for risk assessment in chronic obstructive pulmonary disease (COPD). However, choice of parameters and score complexity restrict clinical applicability. Our aim was to provide and validate a simplified COPD risk index independent of lung function. The PROMISE study (n=530) was used to develop a novel prognostic index. Index performance was assessed regarding 2-year COPD-related mortality and all-cause mortality. External validity was tested in stable and exacerbated COPD patients in the ProCOLD, COCOMICS and COMIC cohorts (total n=2988). Using a mixed clinical and statistical approach, body mass index (B), severe acute exacerbations of COPD frequency (AE), modified Medical Research Council dyspnoea severity (D) and copeptin (C) were identified as the most suitable simplified marker combination. 0, 1 or 2 points were assigned to each parameter and totalled to B-AE-D or B-AE-D-C. It was observed that B-AE-D and B-AE-D-C were at least as good as BODE (body mass index, airflow obstruction, dyspnoea, exercise capacity), ADO (age, dyspnoea, airflow obstruction) and DOSE (dyspnoea, obstruction, smoking, exacerbation) indices for predicting 2-year all-cause mortality (c-statistic: 0.74, 0.77, 0.69, 0.72 and 0.63, respectively; Hosmer-Lemeshow test all p>0.05). Both indices were COPD specific (c-statistic for predicting COPD-related 2-year mortality: 0.87 and 0.89, respectively). External validation of B-AE-D was performed in COCOMICS and COMIC (c-statistic for 1-year all-cause mortality: 0.68 and 0.74; c-statistic for 2-year all-cause mortality: 0.65 and 0.67; Hosmer-Lemeshow test all p>0.05). The B-AE-D index, plus copeptin if available, allows a simple and accurate assessment of COPD-related risk. The B-AE-D indices allow a simple and accurate assessment of COPD-related risk in the absence of lung function

Published
2016

5. 10 Years After EPISCAN: A New Study on the Prevalence of COPD in Spain—A Summary of the EPISCAN II Protocol.

Author

Alfageme, Inmaculada, de Lucas, Pilar, Ancochea, Julio, Miravitlles, Marc, Soler-Cataluña, Juan José, García-Río, Francisco, Casanova, Ciro, Rodríguez González-Moro, José Miguel, Cosío, Borja G., Sánchez, Guadalupe, and Soriano, Joan B.

Abstract

Copyright of Archivos de Bronconeumología (English Edition) is the property of Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2019
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6. Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients.

Author

Zagaceta, Jorge, Bastarrika, Gorka, Zulueta, Javier J., Colina, Inmaculada, Alcaide, Ana B., Campo, Arantza, Divo, Miguel, Casanova, Ciro, Marin, José M., Pinto-Plata, Victor M., Celli, Bartolome R., and de-Torres, Juan P.

Subjects
OBSTRUCTIVE lung diseases, CARDIOVASCULAR diseases, PATIENTS, CORONARY arteries, HYPERTENSION, PROGNOSIS, DISEASE risk factors, CARDIOVASCULAR disease diagnosis, OBSTRUCTIVE lung disease diagnosis, COMPARATIVE studies, LONGITUDINAL method, RESEARCH methodology, MEDICAL cooperation, RESEARCH, SMOKING, SPIROMETRY, EVALUATION research, CALCINOSIS, DIAGNOSIS
Abstract

Background: Chronic Obstructive Pulmonary Disease (COPD) is an independent risk factor for cardiovascular (CV) disease, one of the most frequent causes of death in COPD patients. The goal of the present study was to evaluate the prognostic value of non-invasive CV risk markers in COPD patients.Methods: CV risk was prospectively evaluated in 287 COPD patients using non-invasive markers including the Framingham score, the Systematic Coronary Risk Evaluation (SCORE) charts, coronary arterial calcium (CAC), epicardial adipose tissue (EAT), as well as clinical, biochemical and physiological variables. The predictive power of each parameter was explored using CV events as the main outcome.Results: During a median follow up of 65 months (ICR: 36-100), 44 CV events were recorded, 12 acute myocardial infarctions (27.3%), 10 ischemic heart disease/angina (22.7%), 12 peripheral artery disease events requiring surgery (27.3%) and 10 strokes (22.7%). A total of 35 CV deaths occurred during that period. Univariable analysis determined that age, hypertension, CRP, total Cholesterol, LDL-Cholesterol, Framingham score and CAC were independently associated with CV events. Multivariable analysis identified CAC as the best predictor of CV events (HR; 95%CI: 1.32; 1.19-1.46, p < 001).Conclusions: In COPD patients attending pulmonary clinics, CAC was the best independent non-invasive predictor of CV events. This tool may help evaluate the risk for a CV event in patients with COPD. Larger studies should reproduce and validate these findings. [ABSTRACT FROM AUTHOR]

Published
2017
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7. Is COPD a Progressive Disease? A Long Term Bode Cohort Observation.

Author

de-Torres, Juan P., Marín, Jose M., Pinto-Plata, Víctor, Divo, Miguel, Sanchez-Salcedo, Pablo, Zagaceta, Jorge, Zulueta, Javier J., Berto, Juan, Cabrera, Carlos, Celli, Bartolome R., and Casanova, Ciro

Subjects
OBSTRUCTIVE lung diseases, SPIROMETRY, DISEASE progression, RESPIRATORY obstructions, BODY mass index, FOLLOW-up studies (Medicine)
Abstract

Background: The Global Initiative for Obstructive Lung Diseases (GOLD) defines COPD as a disease that is usually progressive. GOLD also provides a spirometric classification of airflow limitation. However, little is known about the long-term changes of patients in different GOLD grades. Objective: Explore the proportion and characteristics of COPD patients that change their spirometric GOLD grade over long-term follow-up. Methods: Patients alive for at least 8 years since recruitment and those who died with at least 4 years of repeated spirometric measurements were selected from the BODE cohort database. We purposely included the group of non survivors to avoid a “survival selection” bias. The proportion of patients that had a change (improvement or worsening) in their spirometric GOLD grading was calculated and their characteristics compared with those that remained in the same grade. Results: A total of 318 patients were included in the survivor and 217 in the non-survivor groups. Nine percent of survivors and 11% of non survivors had an improvement of at least one GOLD grade. Seventy one percent of survivors and non-survivors remained in the same GOLD grade. Those that improved had a greater degree of airway obstruction at baseline. Conclusions: In this selected population of COPD patients, a high proportion of patients remained in the same spirometric GOLD grade or improved in a long-term follow-up. These findings suggest that once diagnosed, COPD is usually a non-progressive disease. [ABSTRACT FROM AUTHOR]

Published
2016
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8. IL-8 Gene Variants are Associated with Lung Function Decline and Multidimensional BODE Index in COPD Patients But Not with Disease Susceptibility: A Validation Study.

Author

Córdoba-Lanús, Elizabeth, Baz-Dávila, Rebeca, Espinoza-Jiménez, Adriana, Rodríguez-Pérez, María C., Varo, Nerea, de-Torres, Juan P., González-Almeida, Delia, Aguirre-Jaime, Armando, and Casanova, Ciro

Subjects
INTERLEUKIN-8, OBSTRUCTIVE lung diseases, CHEMOKINES, SMOKING, CYTOKINES, SPIROMETRY, GENETIC polymorphisms, PULMONARY function tests
Abstract

Background and objective: COPD is a leading cause of dead worldwide and tobacco smoking is its major risk factor. IL8 is a proinflammatory chemokine mainly involved in the acute inflammatory reaction. The aim of this study was to test the association of IL-8, CXCR1 and CXCR2 gene variants and COPD susceptibility as part of a replication study and explore the effect of these variations in disease progression. Methods: 9 tagSNPs were genotyped in 728 Caucasian individuals (196 COPD patients, 80 smokers and 452 non-smoking controls). Pulmonary compromise was evaluated using spirometry and clinical parameters at baseline and annually over a 2 years period. We also determined plasma levels of TNF-α, IL-6, IL-8 and IL-16 in COPD patients. Results: There was a lack of association between gene variants or haplotypes with predisposition to COPD. No correlation was observed between the polymorphisms and cytokines levels. Interestingly, significant associations were found between carriers of the rs4073A (OR = 3.53, CI 1.34-9.35, p = 0.01), rs2227306C (OR = 5.65, CI 1.75-18.88, p = 0.004) and rs2227307T (OR = 4.52, CI = 1.49-12.82, p = 0.007) alleles in the IL-8 gene and patients who scored higher in the BODE index and showed an important decrease in their FEV1 and FVC during the 2 years follow-up period ( p < 0.05). Conclusions: Despite no association was found between the studied genes and COPD susceptibility, three polymorphisms in the IL-8 gene appear to be involved in a worse progression of the disease, with an affectation beyond the pulmonary function and importantly, a reduction in lung function along the follow-up years. [ABSTRACT FROM AUTHOR]

Published
2015
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9. New GOLD classification: longitudinal data on group assignment.

Author

Casanova, Ciro, Marin, Jose M., Martinez-Gonzalez, Cristina, de Lucas-Ramos, Pilar, Mir-Viladrich, Isabel, Cosio, Borja, Peces-Barba, German, Calle-Rubio, Miryam, Solanes-García, Ingrid, Agüero, Ramón, de Diego-Damia, Alfredo, Feu-Collado, Nuria, Alfageme, Inmaculada, Irigaray, Rosa, Balcells, Eva, Llunell, Antonia, Galdiz, Juan Bautista, Marín, Margarita, Soler-Cataluña, Juan José, and Lopez-Campos, Jose Luis

Subjects
*OBSTRUCTIVE lung diseases, *SPIROMETRY, *DISEASE progression, *LONGITUDINAL method, *DYSPNEA
Abstract

Rationale: Little is known about the longitudinal changes associated with using the 2013 update of the multidimensional GOLD strategy for chronic obstructive pulmonary disease (COPD). Objective: To determine the COPD patient distribution of the new GOLD proposal and evaluate how this classification changes over one year compared with the previous GOLD staging based on spirometry only. Methods: We analyzed data from the CHAIN study, a multicenter observational Spanish cohort of COPD patients who are monitored annually. Categories were defined according to the proposed GOLD: FEV1%, mMRC dyspnea, COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), and exacerbations-hospitalizations. One-year follow-up information was available for all variables except CCQ data. Results: At baseline, 828 stable COPD patients were evaluated. On the basis of mMRC dyspnea versus CAT, the patients were distributed as follows: 38.2% vs. 27.2% in group A, 17.6% vs. 28.3% in group B, 15.8% vs. 12.9% in group C, and 28.4% vs. 31.6% in group D. Information was available for 526 patients at one year: 64.2% of patients remained in the same group but groups C and D show different degrees of variability. The annual progression by group was mainly associated with one-year changes in CAT scores (RR, 1.138; 95%CI: 1.074-1.206) and BODE index values (RR, 2.012; 95%CI: 1.487-2.722). Conclusions: In the new GOLD grading classification, the type of tool used to determine the level of symptoms can substantially alter the group assignment. A change in category after one year was associated with longitudinal changes in the CAT and BODE index. [ABSTRACT FROM AUTHOR]

Published
2014
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10. 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

Author

Masanori Yoshikawa, Daisy J.A. Janssen, Selina Dürr, Rudolf Joerres, Julia Billington, Nicholas Locantore, Florin Mihaltan, Sally Singh, Dimitar Sajkov, Thys van der Molen, Borja G. Cosío, Guilherme F. da Silva, Sarah Houben-Wilke, Ian Norman, Baykal Tulek, Jose M. Marin, David Miedinger, Samantha Coster, Janwillem W. H. Kocks, Sang Do Lee, Karel Hejduk, Juan P. de Torres, Maria Gonik, Mark Small, Samantha S.C. Kon, Nobuyuki Horita, Katherine A. Webb, Naseh Sigari, Ioanna Tsiligianni, Natya Raghavan, Yoshitaka Ogata, William D.-C. Man, Afroditi K. Boutou, Cristina Martínez, Marc Miravitlles, Lowie E.G.W. Vanfleteren, Miriam T.J. Groenen, Barbora Novotna, Isabel Mir, Miguel Guimaraes, Alvar Agusti, Nart Bedin Atalay, Dionne E. Smid, Trevor Murrells, Stefanie Brighenti-Zogg, Henrik Watz, Seigo Minami, José Luis López-Campos, Frits M.E. Franssen, Nicholas S Hopkinson, Pilar de Lucas-Ramos, Emiel F.M. Wouters, James Piercy, Melissa Jehn, Emma Chaplin, Vladimir Koblizek, Ciro Casanova, Nikolaos Tzanakis, Rebecca Tanner, Hiroshi Kimura, Lana Maricic, Nienke Nakken, David Price, Alberto Fernández-Villar, Denis E. O'Donnell, Annika Karch, Martijn A. Spruit, Yu-Il Kim, Joan B. Soriano, Ines Ladeira, Yu Nishijima, Namhee Kwon, Victoria Higgins, Laura Mendoza, Eanes Delgado Barros Pereira, Julia L. Kelly, Thomas Ringbaek, Guogang G. Xie, Chaicharn Pothirat, James W. Dodd, Joerg D. Leuppi, RS: NUTRIM - R3 - Respiratory & Age-related Health, Pulmonologie, Afdeling Onderwijs FHML, RS: NUTRIM - R3 - Chronic inflammatory disease and wasting, Promovendi NTM, MUMC+: MA Longziekten (3), [Smid, Dionne E.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Franssen, Frits M. E.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Groenen, Miriam T. J.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Houben-Wilke, Sarah] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Janssen, Daisy J. A.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Nakken, Nienke] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Vanfleteren, Lowie E. G. W.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Wouters, Emiel F. M.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Spruit, Martijn A.] CIRO, Dept Res & Educ, Hornerheide 1, NL-6085 NM Horn, Netherlands, [Franssen, Frits M. E.] Maastricht Univ, Med Ctr, Dept Resp Med, Maastricht, Netherlands, [Vanfleteren, Lowie E. G. W.] Maastricht Univ, Med Ctr, Dept Resp Med, Maastricht, Netherlands, [Wouters, Emiel F. M.] Maastricht Univ, Med Ctr, Dept Resp Med, Maastricht, Netherlands, [Gonik, Maria] Biomax Informat AG, Planegg, Germany, [Miravitlles, Marc] Hosp Univ Hebron, CIBER Enfermedades Resp CIBERES, Pneumol Dept Hosp, Barcelona, Spain, [Casanova, Ciro] Hosp Univ NS Candelaria, Pulmonaty Dept, Santa Cruz de Tenerife, Spain, [Casanova, Ciro] Hosp Univ NS Candelaria, Res Unit, Santa Cruz de Tenerife, Spain, [Cosio, Borja G.] Hosp Son Espases IdISPa CIBERES, Dept Resp Med, Islas Baleares, Spain, [de Lucas-Ramos, Pilar] Hosp Gen Univ Gregorio Maranon, Pulm Dept, Madrid, Spain, [Marin, Jose M.] Hosp Univ Miguel Servet, IISAragon, CIBER Enfermedades Resp, Zaragoza, Spain, [Martinez, Cristina] Hosp Univ Cent Asturias, Inst Nacl Silicosis, Pneumol Serv, Oviedo, Spain, [Mir, Isabel] Hosp Gen Univ Gregorio Maranon, Pulm Dept, Madrid, Spain, [Soriano, Joan B.] Univ Autonoma Madrid, Hosp Univ Princesa, Inst Invest, IISP, Madrid, Spain, [de Torres, Juan P.] Clin Univ Navarra, Pulm Dept, Pamplona, Spain, [Agusti, Alvar] Univ Barcelona, Hosp Clin, Resp Inst, Barcelona, Spain, [Agusti, Alvar] CIBERES, Madrid, Spain, [Atalay, Nart B.] TOBB Univ Econ & Technol, Dept Psychol, Ankara, Turkey, [Billington, Julia] Surbiton Hlth Ctr, Cent Surg, Surrey, England, [Boutou, Afroditi K.] G Gennimats Gen Hosp, Intens Care Unit, Thessaloniki, Greece, [Boutou, Afroditi K.] Aristotle Univ Thessaloniki, Resp Failure Unit, Thessaloniki, Greece, [Brighenti-Zogg, Stefanie] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Durr, Selina] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Leuppi, Joerg D.] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Miedinger, David] Univ Clin Med, Cantonal Hosp Baselland, Liestal, Switzerland, [Chaplin, Emma] Univ Hosp Leicester NHS Trust, NIHR Leicester Resp Biomed Res Unit, Ctr Exercise & Rehabil Sci, Leicester, Leics, England, [Singh, Sally] Univ Hosp Leicester NHS Trust, NIHR Leicester Resp Biomed Res Unit, Ctr Exercise & Rehabil Sci, Leicester, Leics, England, [Coster, Samantha] Kings Coll London, Florence Nightingale Fac Nursing & Midwifery, London, England, [Murrells, Trevor J.] Kings Coll London, Florence Nightingale Fac Nursing & Midwifery, London, England, [Norman, Ian J.] Kings Coll London, Florence Nightingale Fac Nursing & Midwifery, London, England, [Dodd, James W.] Univ Bristol, Southmead Hosp Bristol, North Bristol Lung Ctr, Acad Resp Unit, Bristol, Avon, England, [Fernandez-Villar, Alberto] Complexo Hosp Vigo, Inst Invest Biomed Vigo, Serv Neumol, Pontevedra, Spain, [Guimaraes, Miguel] Ctr Hosp Vila Nova Gaia Espinho, Pulmonol Dept, Vila Nova De Gaia, Portugal, [Ladeira, Ines] Ctr Hosp Vila Nova Gaia Espinho, Pulmonol Dept, Vila Nova De Gaia, Portugal, [Hejduk, Karel] Masaryk Univ, Fac Med, Inst Biostat & Analyses, Brno, Czech Republic, [Higgins, Victoria] Adelphi Real World, Bollington, England, [Piercy, James] Adelphi Real World, Bollington, England, [Small, Mark] Adelphi Real World, Bollington, England, [Hopkinson, Nicholas S.] Imperial Coll London, Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Tanner, Rebecca J.] Imperial Coll London, Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Horita, Nobuyuki] Yokohama City Univ, Grad Sch Med, Dept Pulmonol, Yokohama, Kanagawa, Japan, [Jehn, Melissa] Charite Univ Med Berlin, Arbeitsbereich Ambulante Pneumol, Berlin, Germany, [Joerres, Rudolf] Inst & Output Clin Occupat & Environm Med, Munich, Germany, [Karch, Annika] Hannover Med Sch, Inst Biostat, Hannover, Germany, [Kelly, Julia L.] Imperial Coll London, NIHR Resp Dis Biomed Res Unit Royal Brompton, Natl Heart & Lung Inst, Acad Unit Sleep & Ventilat, London, England, [Kelly, Julia L.] Harefield NHS Fdn Trust & Imperial Coll, London, England, [Kim, Yu-Il] Chonnam Natl Univ Hosp, Dept Internal Med, Div Pulmonol, Donggu, Gwangju, South Korea, [Kimura, Hiroshi] Nara Med Univ, Dept Internal Med 2, Nara, Japan, [Yoshikawa, Masanori] Nara Med Univ, Dept Internal Med 2, Nara, Japan, [Koblizek, Vladimir] Charles Univ Prague, Fac Med Hradec Kralove, Dept Pneumol, Hradec Kralove, Czech Republic, [Novotna, Barbora] Charles Univ Prague, Fac Med Hradec Kralove, Dept Pneumol, Hradec Kralove, Czech Republic, [Koblizek, Vladimir] Univ Hosp Hradec Kralove, Hradec Kralove, Czech Republic, [Novotna, Barbora] Univ Hosp Hradec Kralove, Hradec Kralove, Czech Republic, [Kocks, Janwillem H.] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Primary Care, Groningen, Netherlands, [van der Molen, Thys] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Primary Care, Groningen, Netherlands, [Tsiligianni, Ioanna G.] Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Primary Care, Groningen, Netherlands, [Kocks, Janwillem H.] Univ Groningen, Univ Med Ctr Groningen, GRIAC, COPD, Groningen, Netherlands, [van der Molen, Thys] Univ Groningen, Univ Med Ctr Groningen, GRIAC, COPD, Groningen, Netherlands, [Tsiligianni, Ioanna G.] Univ Groningen, Univ Med Ctr Groningen, GRIAC, COPD, Groningen, Netherlands, [Kon, Samantha S. C.] Hillingdon Hosp NHS Fdn Trust, Uxbridge, Middx, England, [Kon, Samantha S. C.] Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Man, William D-C] Royal Brompton & Harefield NHS Fdn Trust, NIHR Resp Biomed Res Unit, London, England, [Kon, Samantha S. C.] Imperial Coll, London, England, [Man, William D-C] Imperial Coll, London, England, [Kwon, Namhee] GlaxoSmithICline GSK, Resp Franchise Med, London, England, [Lee, Sang-Do] Univ Ulsan, Coll Med, Clin Res Ctr Chron Obstruct Airway Dis, Asan Med Ctr,Dept Pulm & Critical Care Med, Seoul, South Korea, [Locantore, Nicholas] GlaxoSmithICline, King Of Prussia, PA USA, [Lopez-Campos, Jose L.] Univ Seville, Hosp Univ Virgen Rocio, Inst Biomed Sevilla, Unidad MedQuirarg Enfermedades Resp, Seville, Spain, [Lopez-Campos, Jose L.] Inst Salud Carlos III, CIBERES, CIBER Enfermedades Resp, Madrid, Spain, [Maricic, Lana] Univ JJ Strossmayer Osijek, Fac Med, Dept Internal Med, Univ Hosp Osijek, Osijek, Croatia, [Mendoza, Laura] Hosp Clin Univ Chile, Independencia, Region Metropol, Chile, [Mihaltan, Florin] Inst Pneumol Marius Nasta, Bucharest, Romania, [Minami, Seigo] Osaka Police Hosp, Dept Resp Med, Osaka, Japan, [Nishijima, Yu] Osaka Police Hosp, Dept Resp Med, Osaka, Japan, [Ogata, Yoshitaka] Osaka Police Hosp, Dept Resp Med, Osaka, Japan, [Nishijima, Yu] Osaka Univ, Grad Sch Med, Dept Resp Med Allergy & Rheumat Dis, Suita, Osaka, Japan, [O'Donnell, Denis E.] Queens Univ & Kingston Gen Hosp, Dept Med, Kingston, ON, Canada, [Webb, Katherine A.] Queens Univ & Kingston Gen Hosp, Dept Med, Kingston, ON, Canada, [Pereira, Eanes D.] Fed Univ Ceara Brazil, Fortaleza, Ceara, Brazil, [Price, David] Observat & Pragmat Res Inst, Singapore, Singapore, [Price, David] Univ Aberdeen, Aberdeen, Scotland, [Pothirat, Chaicharn] Chiang Mai Univ, Fac Med, Dept Internal Med, Div Pulm Crit Care & Allergy, Chiang Mai, Thailand, [Raghavan, Natya] McMaster Univ, Dept Med, Hamilton, ON, Canada, [Ringbaek, Thomas] Univ Copenhagen, Hvidovre Hosp, Dept Resp Med, Copenhagen, Denmark, [Sajkov, Dimitar] Flinders Med Ctr, Australian Resp & Sleep Med Inst, Adelaide, SA, Australia, [Sigari, Naseh] Kurdistan Univ Med Sci, Med Fac, Internal Med Dept, Sanandaj, Iran, [da Silva, Guilherme F.] Univ Fortaleza, UNIFOR, Fortaleza, Ceara, Brazil, [Tsiligianni, Ioanna G.] Agia Barbara Hlth Care Ctr, Iraklion, Greece, [Tulek, Baykal] Selcuk Univ, Fac Med, Dept Chest Dis, Konya, Turkey, [Tulek, Baykal] Univ Crete, Med Sch, Univ Hosp Herakl, Dept Thorac Med, Iraklion, Greece, [Watz, Henrik] German Ctr Lung Res, Pulm Res Inst, Lung Clin Grosshansdorf, Grosshansdorf, Germany, [Xie, Guogang G.] Shanghai Jiao Tong Univ, Shanghai Gen Hosp, Dept Resp Med, Shanghai, Peoples R China, [Spruit, Martijn A.] Hasselt Univ, Fac Med & Life Sci, Biomed Res Inst, REVAL,Rehabil Res Ctr,BIOMED, Diepenbeek, Belgium, [Spruit, Martijn A.] Maastricht Univ, Med Ctr, NUTRIM Sch Nutr & Translat Res Metab, Dept Resp Med, Maastricht, Netherlands, MRC, National Institute for Health Research, Medical Research Council, Department of Health, Medical Research Council (MRC), EU/IMI Joint Undertaking, TOBB ETU, Faculty of Science and Literature, Department of Psychology, TOBB ETÜ, Fen Edebiyat Fakültesi, Psikoloji Bölümü, Atalay, Nart Bedin, and Groningen Research Institute for Asthma and COPD (GRIAC)

Subjects
ASSESSMENT TEST SCORE, Male, clinical significance, health status, HISTORY ASSESSMENT, Global Health, Severity of Illness Index, Pulmonary Disease, Chronic Obstructive, 0302 clinical medicine, Assessment test score, Quality of life, CLINICAL CHARACTERISTICS, QUALITY-OF-LIFE, Sickness Impact Profile, 030212 general & internal medicine, Prospective cohort study, Copd assessment test, General Nursing, POPULATION, COPD, education.field_of_study, HEALTH-STATUS, COPD ASSESSMENT TEST, Evidence-Based Medicine, medicine.diagnostic_test, Health Policy, Age Factors, Cat, CAT, General Medicine, Middle Aged, Obstructive lung disease, Health-status, 3. Good health, 1117 Public Health And Health Services, Practice Guidelines as Topic, Disease Progression, Female, Symptom Assessment, Research-council scale, Spirometry, medicine.medical_specialty, Population, Risk Assessment, 03 medical and health sciences, Sex Factors, Internal medicine, Severity of illness, medicine, Humans, GOLD, education, Aged, Receiver operating characteristic, Clinical characteristics, business.industry, 1103 Clinical Sciences, medicine.disease, RESEARCH-COUNCIL SCALE, History assessment, PHYSICAL-ACTIVITY, 030228 respiratory system, Geriatrics, Physical therapy, Physical-activity, Quality-of-life, Geriatrics and Gerontology, business
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.

Published
2017

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