Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores: a cross-sectional analyses

Kim, Sunmin; Oh, Jisun; Kim, Yu-Il; Ban, Hee Jung; Kwon, Yong Soo; Oh, Il‐Seok; Kim, Kyu‐Sik; Kim, Young‐Chul; Lim, Sung‐Chul

doi:10.1186/1471-2466-13-35

Cited by 88 publications

(86 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Additionally, several groups have demonstrated that the new GOLD multidimensional system classification does not improve prognostic reliability compared with the previous classification based only on spirometric severity for the prediction of mortality and hospitalizations. Indeed, mortality at 3 years was higher in GOLD group B (more symptoms, less risk) than in group C (more risk, fewer symptoms) [17], [36]–[38]. A possible explanation is that patients in group B have more comorbidities, and therefore more symptoms despite better spirometric values [39]–[40]…”

Section: Discussionmentioning

confidence: 99%

Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study

Almagro

Martínez‐Camblor²,

Soriano³

et al. 2014

PLoS ONE

View full text Add to dashboard Cite

BackgroundFEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence.ObjectivesWe aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients.Design and MethodsWe conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival.ResultsA total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4±9.7, and predicted FEV1 of 53.8% (±19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥70%, moderate 56–69%, severe 36–55%, and very severe ≤35%. Survival at 5 years was 0.89 for patients with FEV1≥70 vs. 0.46 in patients with FEV1 ≤35% (H.R: 6; 95% C.I.: 4.69–7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear.ConclusionsThe best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥70%, 56–69%, 36–55%, and ≤35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.

show abstract

Section: Discussionmentioning

confidence: 99%

Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study

Almagro

Martínez‐Camblor²,

Soriano³

et al. 2014

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The discordance is deepened further by the fact that dyspnea severity is significantly associated with active smoking. Several studies have cast doubts on the equivalence between dyspnea grade and CAT score in the evaluation of disease involvement 37,38. Indeed, recent evidence shows that the isolated use of CAT as a tool to establish the impact and severity of COPD may be inappropriate, given the difficulty of establishing definite cutoff points for a sufficiently sensitive and specific classification of patients according to their severity 39.…”

Section: Discussionmentioning

confidence: 99%

Active smoking and COPD phenotype: distribution and impact on prognostic factors

Riesco¹,

Alcázar²,

Trigueros³

et al. 2017

COPD

View full text Add to dashboard Cite

PurposeSmoking can affect both the phenotypic expression of COPD and factors such as disease severity, quality of life, and comorbidities. Our objective was to evaluate if the impact of active smoking on these factors varies according to the disease phenotype.Patients and methodsThis was a Spanish, observational, cross-sectional, multicenter study of patients with a diagnosis of COPD. Smoking rates were described among four different phenotypes (non-exacerbators, asthma-COPD overlap syndrome [ACOS], exacerbators with emphysema, and exacerbators with chronic bronchitis), and correlated with disease severity (body mass index, obstruction, dyspnea and exacerbations [BODEx] index and dyspnea grade), quality of life according to the COPD assessment test (CAT), and presence of comorbidities, according to phenotypic expression.ResultsIn total, 1,610 patients were recruited, of whom 46.70% were classified as non-exacerbators, 14.53% as ACOS, 16.37% as exacerbators with emphysema, and 22.40% as exacerbators with chronic bronchitis. Smokers were predominant in the latter 2 groups (58.91% and 57.67%, respectively, P=0.03). Active smoking was significantly associated with better quality of life and a higher dyspnea grade, although differences were observed depending on clinical phenotype.ConclusionActive smoking is more common among exacerbator phenotypes and appears to affect quality of life and dyspnea grade differently, depending on the clinical expression of the disease.

show abstract

“…However, Jones et al [6] and Kim et al [7] have shown that a CAT score ≥10 might not be equivalent to an mMRC score ≥2, when classifying patients into low or high symptom groups. To improve the interrater agreement, they suggested using a cut-point of mMRC ≥1 [6, 7]. The present investigation confirmed the fair agreement between CAT and mMRC.…”

Section: Discussionmentioning

confidence: 99%

Differences in classification of COPD patients into risk groups A-D: a cross-sectional study

Zogg

Dürr²,

Malka

et al. 2014

BMC Res Notes

View full text Add to dashboard Cite

BackgroundThe Global Initiative for Chronic Obstructive Lung Disease proposed in 2011 a new system to classify chronic obstructive pulmonary disease (COPD) patients into risk groups A-D, which considers symptoms and future exacerbation risk to grade disease severity. The aim of this study was to investigate the agreement between COPD risk group classifications using COPD assessment test (CAT) or modified Medical Research Council (mMRC) and severity grades or past-year exacerbations. Furthermore, physical activity across risk groups was examined.Methods87 patients with stable COPD were classified into risk groups A-D. CAT and mMRC were completed. Severity grades I-IV were determined using spirometry and the number of past-year exacerbations was recorded. To test the interrater agreement, Cohen’s Kappa was calculated. Daily physical activity was measured by the SenseWear Mini armband.ResultsUsing CAT, 65.5% of patients were in high-symptom groups (B and D). With mMRC, only 37.9% were in B and D. Using severity grades, 20.7% of patients were in high-exacerbation risk groups (C and D). With past-year exacerbations, 9.2% were in C and D. Interrater agreement between CAT and mMRC (κ = 0.21) and between severity grades and past-year exacerbations (κ = 0.31) was fair. Daily steps were reduced in risk groups B and C + D compared to A (p < 0.01), using either classification.ConclusionsWhen classifying COPD patients into risk groups A-D, the use of CAT or mMRC and severity grades or past-year exacerbations does not provide equal results. Daily steps decreased with increasing COPD risk groups.

show abstract

Differences in classification of COPD group using COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores: a cross-sectional analyses

Cited by 88 publications

References 18 publications

Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study

Finding the Best Thresholds of FEV1 and Dyspnea to Predict 5-Year Survival in COPD Patients: The COCOMICS Study

Active smoking and COPD phenotype: distribution and impact on prognostic factors

Differences in classification of COPD patients into risk groups A-D: a cross-sectional study

Contact Info

Product

Resources

About