Validation of the COPD severity score for use in primary care: the NEREA study

Miravitlles, Marc; Llor, Carles; Castellar, R de; Izquierdo, Iñaki; Baró, Eva; Donado, Esther

doi:10.1183/09031936.00087208

Cited by 37 publications

(46 citation statements)

References 33 publications

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“…We used the COPDSS to control for severity. The COPDSS is a valid survey-based measure of disease-specific severity, both in terms of concurrent and predictive validity [11,12,13]. A major advantage of this score is that it does not require lung function or other physical measurements, facilitating its use in large-scale epidemiologic studies in COPD.…”

Section: Discussionmentioning

confidence: 99%

“…Possible total scores range from 0 to 35, and higher scores reflect more severe COPD [11] and have demonstrated predictive validity through their association with a greater prospective risk of exacerbations of COPD [12]. The questionnaire has been translated and validated into Spanish [13]. (3) The overall burden of comorbid diseases was assessed by the Charlson comorbidity score [14].…”

Section: Methodsmentioning

confidence: 99%

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Socioeconomic Status and Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease

Miravitlles

Naberán²,

Cantoni³

et al. 2011

Respiration

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Background: Socioeconomic status (SES) is an important determinant of health and premature death. However, the impact of poor SES on the health status of patients with chronic obstructive pulmonary disease (COPD) has not been well determined. Objective: It was our aim to assess the impact of SES on the quality of life in COPD patients. Methods: This was a cross-sectional, observational, multicenter study. A total of 4,574 patients completed the EuroQol 5-dimension questionnaire (EQ-5D) and the Airways Questionnaire 20 (AQ20). SES was based on the subject’s occupation and educational level. Occupational categories were based on the major group classification of the International Standard Classification of Occupations. Results: The mean age of the population was 67.1 years and the mean forced expiratory volume was 43.4%. There was a gradient of impairment in health-related quality of life (HRQoL) according to the educational level, with significantly worse scores for the EQ-5D and the AQ20 for medium and low educational levels compared with high education (p < 0.001). Similarly, HRQoL was also significantly impaired in more unskilled workers, with a gradient of the AQ20 from 8.6 units (SD 4.8) in class I to 10.1 units (4.6) in class V (p < 0.001) and from 0.75 units in class I to 0.63 units in class V for the EQ-5D index, as well as from 62.9 units in class I to 55.6 units in class V for the EQ-5D visual analogue scale (p < 0.001 for all comparisons). These differences remained significant after controlling for covariates. Conclusions: Patients with a lower educational level and belonging to the unskilled professional groups had a poorer HRQoL. This is evident even in a country where access to health care services is universal and free.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Socioeconomic Status and Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease

Miravitlles

Naberán²,

Cantoni³

et al. 2011

Respiration

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“…We also calculated modifications of the BODE index, including the mBODE (which replaces 6MWD with oxygen uptake) [20], e-BODE (BODE plus exacerbations) [21], and BODEx (substitution of exacerbations for exercise capacity) [21]. We also calculated the ADO index (age, dyspnoea and FEV1) [22], the COPD Prognostic Index (CPI) (quality of life standardised by the Chronic Respiratory Questionnaire (CRQ) or St George's Respiratory Questionnaire (SGRQ), FEV1, age, sex, BMI, exacerbation history and cardiovascular disease history) [23], the SAFE index (quality of life by SGRQ, FEV1 and 6MWD) [24], the HADO index (health status, activity, dyspnoea and FEV1) [25], the COPDSS-COPD severity score (respiratory symptoms, systemic corticosteroid use, other COPD medication use, previous hospitalisation or intubation for respiratory disease and home oxygen use) [26,27], TARDIS (age, BMI, dyspnoea, airflow obstruction, hospitalisations and influenza vaccination) [28], and the DOSE index (dyspnoea, smoking status, FEV1 and prior exacerbation history) [29]. Comorbidities were quantified by means of the Charlson index, excluding COPD [30].…”

Section: Indices Calculationsmentioning

confidence: 99%

Multicomponent indices to predict survival in COPD: the COCOMICS study

Marı́n

Alfageme²,

Almagro

et al. 2012

Eur Respir J

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Guidelines recommend defining chronic obstructive pulmonary disease (COPD) by airflow obstruction and other factors, but no studies have evaluated the ability of existing multicomponent indices to predict mortality up to 10 years.We conducted a patient-based pooled analysis. Survival analysis and C statistics were used to determine the best COPD index/indices according to several construct variables and by varying time-points. Individual data of 3633 patients from 11 COPD cohorts were collected, totalling the experience of 15 878 person-years.Overall, there were 1245 death events within our cohorts, with a Kaplan-Meier survival of 0.963 at 6 months, which was reduced to 0.432 at 10 years. In all patients, ADO (age, dyspnoea and forced expiratory volume in 1 s), BODE (body mass index, airflow obstruction, dyspnoea and exercise capacity) and e-BODE (BODE plus exacerbations) were the best indices to predict 6-month mortality. The ADO index was the best to predict 12-month (C statistic 0.702), 5-year (C statistic 0.695) and 10-year mortality (C statistic 0.698), and was significantly better than BODE (all p,0.05). The best indices to predict death by C statistics when adjusting by age were e-BODE, BODEx (substitution of exacerbations for exercise capacity) and BODE.No index predicts short-term survival of COPD well. All BODE modifications scored better than ADO after age adjustment. The ADO and BODE indices are overall the most valid multicomponent indices to predict time to death in all COPD patients. @ERSpublicationsNo index predicts short-term survival of COPD well: all BODE modifications score better than ADO after age adjustment

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“…Existing COPD prognostic indices (PI) mainly focus on predicting mortality risk (17,(33)(34)(35)(36), though others were developed to predict additional outcomes such as exacerbations (37, 38), COPD-related hospitalisation (39), respiratory hospital attendance/admission (40), exacerbation or hospitalisation (41,42). Only three indices (38, 41,42) were derived in primary care populations despite this being where most COPD patients are managed, and most included patients with more severe established disease.…”

Section: Why Was the Cohort Set Up?mentioning

confidence: 99%

Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study

et al. 2016

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Why was the cohort set up?Chronic obstructive pulmonary disease (COPD) affects 5-10% of people worldwide (1), is rising in prevalence (2) and is the third most common cause of death (3). The annual burden of COPD regarding healthcare (mainly exacerbations resulting in emergency admissions) and societal (predominantly lost productivity) costs was estimated to be around $49.9billion in the USA (2010 prices (4)) and €48.4billion in the EU (2011 prices (5)). A substantial proportion of those with COPD are of working age, but there is some evidence that they have poorer employment history (6), higher rate of sickness absence (7) and poorer work performance (presenteeism) (8) compared to the general population.There remains much uncertainty about the natural history of COPD (9, 10) and which interventions are effective in altering the course of early disease. Furthermore, up to 85% of cases (11-13) are undiagnosed; representing many with potentially unmet need. Partly in response to reports (14)(15)(16) highlighting the burden of COPD, extent of underdiagnosis and uncertainty about prognosis of early disease, expert reviews have highlighted a need for further longitudinal data (9, 10). However, established cohorts usually represent secondary care patients with more advanced disease, with short duration of follow up and, generally small samples (17)(18)(19). While large population cohorts have sometimes addressed questions relevant to COPD (20-28), limitations in outcome measures and quality of lung function testing provide insufficient data to inform the COPD arena. Importantly, there are no primary care COPD cohorts with case-found patients and few with patients representing the full range of disease severity, particularly those with mild to moderate disease, and diverse socioeconomic mix.In recent years, several studies have also focused on patients reporting respiratory symptoms but who have normal lung function (former GOLD severity stage 0 (29)). The evidence on progression to COPD is limited and contradictory (23, 30, 31) and methods for assessing symptoms are inconsistent (23, 32). Thus there is also a paucity of evidence on the clinical relevance and natural history for this patient group.Better understanding of natural history and prognostic factors is needed to facilitate consultations, and to inform management decisions and health service planning. Existing COPD prognostic indices (PI) mainly focus on predicting mortality risk (17,(33)(34)(35)(36), though others were developed to predict additional outcomes such as exacerbations (37, 38), COPD-related hospitalisation (39), respiratory hospital attendance/admission (40), exacerbation or hospitalisation (41, 42). Only three indices (38,41,42) were derived in primary care populations despite this being where most COPD patients are managed, and most included patients with more severe established disease. No indices were developed in populations that included case-found patients. The methods and basis for selecting prognostic variables are rarely described, and...

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Validation of the COPD severity score for use in primary care: the NEREA study

Cited by 37 publications

References 33 publications

Socioeconomic Status and Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease

Socioeconomic Status and Health-Related Quality of Life of Patients with Chronic Obstructive Pulmonary Disease

Multicomponent indices to predict survival in COPD: the COCOMICS study

Cohort Profile: The Birmingham Chronic Obstructive Pulmonary Disease (COPD) Cohort Study

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