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Symptomatic Assessment of COPD

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COPD

Abstract

In the absence of formal quantification, subjective assessment of symptoms may be misleading. This chapter reviews a range of symptomatic measurements available for the assessment of COPD patients, focusing in greater depth on the Medical Research Council Dyspnoea Scale, the St George’s Respiratory Questionnaire and the COPD Assessment Test. It will also discuss what has been learnt in terms of symptomatic assessment from diary cards that were developed for monitoring exacerbations. Much has been gained from research studies using instruments that are largely suitable for use except as research tools, but it will illustrate how this knowledge can inform clinical practice. Finally, it will provide practical advice illustrating how symptom assessment can be performed in routine clinical practice, for different purposes, and show how instruments such as the COPD Assessment Test can aid clinical management.

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References

  1. Agusti A, Calverley PMA, Celli B, Coxson HO, Edwards L, Lomas D, et al. Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11(1):122.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Bestall JC, Paul EA, Garrod R, Garnham R, Jones PW, Wedzicha JA. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54(7):581–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Nishimura K, Izumi T, Tsukino M, Oga T. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002;121(5):1434–40.

    Article  PubMed  Google Scholar 

  4. Celli BR, Cote CG, Marin JM, Casanova C, Montes de Oca M, Mendez RA, et al. The body-mass index, airflow obstruction, dyspnea and exercise capacity index in chronic obstructive pulmonary disease. NEJM. 2004;350:1005–12.

    Article  CAS  PubMed  Google Scholar 

  5. Mahler DA, Weinberg DH, Wells CK, Feinstein AR. Measurements of dyspnea. Contents, interobserver correlates of two new clinical indices. Chest. 1984;85:751–8.

    Article  CAS  PubMed  Google Scholar 

  6. Yorke J, Moosavi SH, Shuldham C, Jones PW. Quantification of dyspnoea using descriptors: development and initial testing of the Dyspnoea-12. Thorax. 2010;65(1):21–6.

    Article  CAS  PubMed  Google Scholar 

  7. Leidy NK, Sexton CC, Jones PW, Notte SM, Monz BU, Nelsen L, et al. Measuring respiratory symptoms in clinical trials of COPD: reliability and validity of a daily diary. Thorax. 2014;69(5):443–9.

    Article  CAS  PubMed  Google Scholar 

  8. Leidy NK, Murray LT, Monz BU, Nelsen L, Goldman M, Jones PW, et al. Measuring respiratory symptoms of COPD: performance of the EXACT- Respiratory Symptoms Tool (E-RS) in three clinical trials. Respir Res. 2014;15(1):124.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jones PW, Leidy NK, Hareendran AR, Lamarca, Chuecos F, Garcia Gil E. The effect of aclidinium bromide on daily respiratory symptoms of COPD, measured using the Evaluating Respiratory Symptoms in COPD (E-RS: COPD) diary: pooled analysis of two 6-month phase III studies. Respir Res. 2016;17(1):61.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  10. Hurst JR, Vestbo J, Anzueto A, Locantore N, Müllerova H, Tal-Singer R, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128–38.

    Article  CAS  PubMed  Google Scholar 

  11. Jones PW, Chen W-H, Wilcox TK, Sethi S, Leidy NK, Group E-PS. Characterizing and quantifying the symptomatic features of COPD exacerbations. Chest. 2011;139(6):1388–94.

    Article  PubMed  Google Scholar 

  12. Leidy NK, Wilcox TK, Jones PW, Roberts L, Powers JH, Sethi S, et al. Standardizing measurement of chronic obstructive pulmonary disease exacerbations. Am J Respir Crit Care Med. 2011;183(3):323–9.

    Article  PubMed  Google Scholar 

  13. Rodriguez-Roisin R. Toward a consensus definition for COPD exacerbations. Chest. 2000;117(5 Suppl 2):398S–401S.

    Article  CAS  PubMed  Google Scholar 

  14. Burge S, Wedzicha JA. COPD exacerbations: definitions and classifications. Eur Respir J. 2003;21(41 suppl):46s–53s.

    Article  Google Scholar 

  15. Jones PW, Lamarca R, Chuecos F, Singh D, Agustí A, Bateman ED, et al. Characterisation and impact of reported and unreported exacerbations: results from ATTAIN. Eur Respir J. 2014;44(5):1156–65.

    Article  PubMed  Google Scholar 

  16. Guyatt GH, Berman LB, Townsend M, Pugsley SO, Chambers LW. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987;42:773–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure for chronic airflow limitation—the St George’s respiratory questionnaire. Am Rev Respir Dis. 1992;145:1321–7.

    Article  CAS  PubMed  Google Scholar 

  18. Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014;371(13):1198–207.

    Article  PubMed  CAS  Google Scholar 

  19. Meguro M, Barley EA, Spencer S, Jones PW. Development and validation of an improved COPD-specific version of the St George’s respiratory questionnaire. Chest. 2007;132:456–63.

    Article  PubMed  Google Scholar 

  20. Cope S, Donohue JF, Jansen JP, Kraemer M, Capkun-Niggli G, Baldwin M, et al. Comparative efficacy of long-acting bronchodilators for COPD—a network meta-analysis. Respir Res. 2013;14(1):100.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  21. Sciurba FC, Criner GJ, Strange C, et al. Effect of endobronchial coils vs usual care on exercise tolerance in patients with severe emphysema: the renew randomized clinical trial. JAMA. 2016;315(20):2178–89.

    Article  CAS  PubMed  Google Scholar 

  22. National Emphysema Treatment Trial Research Group. Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema. NEJM. 2003;348:2092–102.

    Article  Google Scholar 

  23. Bernard M, Dympna C, Declan D, Kathy M, Edel M, Yves L. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015;2:CD003793.

    Google Scholar 

  24. McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne effect: a randomised, controlled trial. BMC Med Res Methodol. 2007;7(1):30.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Spencer S, Calverley PMA, Burge PS, Jones PW. Health status deterioration in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163:122–8.

    Article  CAS  PubMed  Google Scholar 

  26. Jones P, Anderson J, Calverley P, Celli B, Ferguson G, Jenkins C, et al. Health status in the TORCH study of COPD: treatment efficacy and other determinants of change. Respir Res. 2011;12(1):71.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Spencer S, Calverley PMA, Burge PS, Jones PW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J. 2004;23(5):698–702.

    Article  CAS  PubMed  Google Scholar 

  28. Oga T, Nishimura K, Tsukino M, Sato S, Hajiro T, Mishima M. Longitudinal deteriorations in patient reported outcomes in patients with COPD. Respir Med. 2007;101(1):146–53.

    Article  PubMed  Google Scholar 

  29. Nagai K, Nishimura M, Makita H, Suzuki M, Shimizu K, Konno S, et al. Differential changes in quality of life components over 5 years in chronic obstructive pulmonary disease patients. COPD. 2015;10(1):745–57.

    Article  Google Scholar 

  30. Wilke S, Jones PW, Mullerova H, Vestbo J, Tal-Singer R, Franssen FME, et al. One-year change in health status and subsequent outcomes in COPD. Thorax. 2015;70(5):420–5.

    Article  PubMed  Google Scholar 

  31. Tashkin DP, Celli B, Senn S, Burkhart D, Kesten S, Menjoge SS, et al. A 4-year trial of tiotropium in chronic obstructive pulmonary disease. N Engl J Med. 2008;359(15):1543–54.

    Article  CAS  PubMed  Google Scholar 

  32. Vestbo J, Anderson JA, Calverley PMA, Celli B, Ferguson GT, Jenkins C, et al. Bias due to withdrawal in long-term randomised trials in COPD: evidence from the TORCH study. Clin Respir J. 2011;5(1):44–9.

    Article  PubMed  Google Scholar 

  33. van der Molen T, Willemse BWM, Schokker S, ten Hacken NHT, Postma DS, Juniper EF. Development, validity and responsiveness of the clinical COPD questionnaire. Health Qual Life Outcomes. 2003;1(1):13.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline LN. Development and first validation of the COPD assessment test. Eur Respir J. 2009;34(3):648–54.

    Article  CAS  PubMed  Google Scholar 

  35. Jones PW, Harding G, Wiklund I, Berry P, Tabberer M, Yu R, et al. Tests of the responsiveness of the COPD assessment test following acute exacerbation and pulmonary rehabilitation COPD assessment test responsiveness. Chest J. 2012;142(1):134–40.

    Article  Google Scholar 

  36. Kwon N-H, Amin M, Hui DS, Jung K-S, Lim SY, Ta HD, et al. Validity of the chronic obstructive pulmonary disease assessment test (CAT) translated into local languages for Asian patients. Chest. 2013;143:703–10.

    Article  PubMed  Google Scholar 

  37. Ställberg B, Nokela M, Ehrs P-O, Hjemdal P, Jonsson EW. Validation of the clinical COPD questionnaire (CCQ) in primary care. Health Qual Life Outcomes. 2009;7(1):1–9.

    Article  Google Scholar 

  38. Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: a systematic review. Eur Respir J. 2014;44(4):873–84.

    Article  PubMed  Google Scholar 

  39. Karloh M, Mayer AF, Maurici R, Pizzichini MMM, Jones PW, Pizzichini E. The COPD assessment test: what do we know so far?: a systematic review and meta-analysis about clinical outcomes prediction and classification of patients into gold stages. Chest. 2016;149(2):413–25.

    Article  PubMed  Google Scholar 

  40. Kon SSC, Canavan JL, Jones SE, Nolan CM, Clark AL, Dickson MJ, et al. Minimum clinically important difference for the COPD assessment test: a prospective analysis. Lancet Respir Med. 2014;2(3):195–203.

    Article  PubMed  Google Scholar 

  41. Singh D, Worsley S, Zhu C-Q, Hardaker L, Church A. Umeclidinium/vilanterol versus fluticasone propionate/salmeterol in COPD: a randomised trial. BMC Pulm Med. 2015;15:91.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Rennard S, DeCramer M, Calverley PMA, Pride NB, Soriano JB, Vermeire PA, et al. Impact of COPD in North America and Europe in 2000: subjects’ perspective of confronting COPD international survey. Eur Respir J. 2002;20:799–805.

    Article  CAS  PubMed  Google Scholar 

  43. Jones PW, Adamek L, Nadeau G, Banik N. Comparisons of health status scores with MRC grades in COPD: implications for the GOLD 2011 classification. Eur Respir J. 2013;42(3):647–54.

    Article  PubMed  Google Scholar 

  44. Jones PW, Bosh TK. Changes in quality of life in COPD patients treated with salmeterol. Am J Respir Crit Care Med. 1997;155:1283–9.

    Article  CAS  PubMed  Google Scholar 

  45. Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, et al. Properties of the COPD assessment test in a cross-sectional European study. Eur Respir J. 2011;38(1):29–35.

    Article  CAS  PubMed  Google Scholar 

  46. Jones PW, Shahrour N, Nejjari C, Lahlou A, Doble A, Rashid N, et al. Psychometric evaluation of the COPD assessment test: data from the BREATHE study in the Middle East and North Africa region. Respir Med. 2012;106(Suppl 2):S86–99.

    Article  PubMed  Google Scholar 

  47. Tsuda T, Suematsu R, Kamohara K, Kurose M, Arakawa I, Tomioka R, et al. Development of the Japanese version of the COPD assessment test. Respir Invest. 2012;50(2):34–9.

    Article  Google Scholar 

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Correspondence to Paul W. Jones Ph.D., F.R.C.P., F.E.R.S. .

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Jones, P.W. (2017). Symptomatic Assessment of COPD. In: Lee, SD. (eds) COPD. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-47178-4_7

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  • DOI: https://doi.org/10.1007/978-3-662-47178-4_7

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