Journal of the American Medical Directors Association
JAMDA OnlineOriginal StudyRedefining 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
Section snippets
Methods
This is a pooled analysis of concurrent cohort studies assessing mMRC and multidimensional evaluation systems in COPD. To identify the original cohorts, we performed a computerized search in the database Medline/Pubmed for reports published from the first CAT publication (September 2009) to June 2015.11 D.S., S.H-W., or M.S. approached the corresponding authors to gather information about their readiness to partake and the availability of a minimum required set of individual data of patients
Results
Overall, 337 reports were identified, of which 63 were eligible (Figure 1). Forty-five author groups were able and willing to participate. Finally, 41 datasets were included in the patient level pooled analysis. At the time of inclusion, 3 articles were published with the dataset of the COPD History Assessment In SpaiN (CHAIN) cohort,14 3 articles used the Adelphi Respiratory Disease Specific Program dataset (one of which is from another subcohort15 than the other 2 articles16, 17), 1 author
Discussion
Healthcare professionals should be aware of the fact that the choice of symptom measure influences classification, and, in turn, also specific treatment recommendation in patients with COPD. Using mMRC ≥2 points as a reference, a CAT cut-point of 18 points, CCQ cut-point of 1.9 points, and SGRQ cut-point of 46.0 points reached the highest agreement. Implementation of these newly derived cut-points will influence the management of individual patients and the design and interpretation of clinical
Conclusions
To objectively define a symptom burden score equivalent to a mMRC dyspnea grade of 2 or higher, a CAT total score of ≥18 points, a CCQ total score of ≥1.9 points, or a SGRQ total score of ≥46 points should be used. Following this grading, about one-third of the patients in GOLD groups B/D are re-classified to GOLD groups A/C. This implies that guidelines committees may consider adapting our evidence-based cut-points of symptom measures.
Acknowledgments
The authors thank all the patients who participated. In addition, they thank J. Jarkovsky, J. Svancara, and M. Svoboda for their help with data collection and validation within the Czech Multicenter Research Database of Severe COPD. Furthermore, the authors acknowledge Nasrin Moghimi, Shilan Mohammadi, Farhad Sabershahraki, and Daem Roshani for their valuable help during the original study performed in the Tohid Hospital. Subsequently, the authors thank R. Casamor for helping with the On-Sint
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Funding information is detailed in Appendix A.
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