Dionne E Smid1, Frits M E Franssen2, Maria Gonik3, Marc Miravitlles4, Ciro Casanova5, Borja G Cosio6, Pilar de Lucas-Ramos7, Jose M Marin8, Cristina Martinez9, Isabel Mir10, Joan B Soriano11, Juan P de Torres12, Alvar Agusti13, Nart B Atalay14, Julia Billington15, Afroditi K Boutou16, Stefanie Brighenti-Zogg17, Emma Chaplin18, Samantha Coster19, James W Dodd20, Selina Dürr17, Alberto Fernandez-Villar21, Miriam T J Groenen22, Miguel Guimarães23, Karel Hejduk24, Victoria Higgins25, Nicholas S Hopkinson26, Nobuyuki Horita27, Sarah Houben-Wilke22, Daisy J A Janssen22, Melissa Jehn28, Rudolf Joerres29, Annika Karch30, Julia L Kelly31, Yu-Il Kim32, Hiroshi Kimura33, Vladimir Koblizek34, Janwillem H Kocks35, Samantha S C Kon36, Namhee Kwon37, Inês Ladeira23, Sang-Do Lee38, Joerg D Leuppi17, Nicholas Locantore39, José L Lopez-Campos40, William D-C Man41, Lana Maricic42, Laura Mendoza43, David Miedinger17, Florin Mihaltan44, Seigo Minami45, Thys van der Molen35, Trevor J Murrells19, Nienke Nakken22, Yu Nishijima46, Ian J Norman19, Barbora Novotna34, Denis E O'Donnell47, Yoshitaka Ogata45, Eanes D Pereira48, James Piercy25, David Price49, Chaicharn Pothirat50, Natya Raghavan51, Thomas Ringbaek52, Dimitar Sajkov53, Naseh Sigari54, Sally Singh18, Mark Small25, Guilherme F da Silva55, Rebecca J Tanner26, Ioanna G Tsiligianni56, Baykal Tulek57, Nikolaos Tzanakis58, Lowie E G W Vanfleteren2, Henrik Watz59, Katherine A Webb47, Emiel F M Wouters2, Guogang G Xie60, Masanori Yoshikawa33, Martijn A Spruit61. 1. Department of Research and Education, CIRO, Horn, The Netherlands. Electronic address: dionnesmid@ciro-horn.nl. 2. Department of Research and Education, CIRO, Horn, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. 3. Biomax Informatics AG, Planegg, Germany. 4. Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain. 5. Pulmonary Department and Research Unit, Hospital Universitario NS La Candelaria, Santa Cruz de Tenerife, Spain. 6. Department of Respiratory Medicine, Hospital Son Espases-IdISPa-CIBERES, Islas Baleares, Spain. 7. Hospital General Universitario Gregorio Marañon, Pulmonary Department, Madrid, Spain. 8. Hospital Universitario Miguel Servet, IISAragon, CIBER Enfermedades Respiratorias, Zaragoza, Spain. 9. Pneumology Service Instituto Nacional de Silicosis-Hospital Universitario Central de Asturias, Oviedo, Spain. 10. Hospital General Universitario Gregorio Marañón, Madrid, Pulmonary Department, Madrid, Spain. 11. Instituto de Investigación Hospital Universitario de la Princesa, IISP, Universidad Autónoma de Madrid, Madrid, Spain. 12. Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain. 13. Respiratory Institute, Hospital Clinic, University of Barcelona and CIBERES, Spain. 14. Department of Psychology, TOBB University of Economics and Technology, Ankara, Turkey. 15. Central Surgery, Surbiton Health Centre, Surbiton, Surrey, United Kingdom. 16. Intensive Care Unit, G Gennimats, General Hospital, Thessaloniki, Greece; Respiratory Failure Unit, Aristotle University of Thessaloniki, Greece. 17. University Clinic of Medicine, Cantonal Hospital Baselland, Liestal, Switzerland. 18. Center for Exercise and Rehabilitation Science, NIHR Leicester Respiratory Biomedical Research Unit, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom. 19. King's College London, Florence Nightingale Faculty of Nursing and Midwifery, London, United Kingdom. 20. Academic Respiratory Unit University of Bristol, North Bristol Lung Centre, Southmead Hospital Bristol, United Kingdom. 21. Servicio de Neumología, Instituto de Investigación Biomédica de Vigo, IBIV, Complexo Hospitalario de Vigo, Vigo, Pontevedra, España. 22. Department of Research and Education, CIRO, Horn, The Netherlands. 23. Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Portugal. 24. Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic. 25. Adelphi Real World, Bollington, United Kingdom. 26. NIHR Respiratory Biomedical Research Unit at Royal Brompton and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom. 27. Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 28. Arbeitsbereich Ambulante Pneumologie, Charité Universitätsmedizin Berlin, Berlin, Germany. 29. Institute and Output Clinic for Occupational and Environmental Medicine, Munich, Germany. 30. Institute for Biostatistics, Hannover Medical School, Hannover, Germany. 31. Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, Imperial College London, NIHR Respiratory Disease Biomedical Research Unit at the Royal Brompton, United Kingdom; Harefield NHS Foundation Trust and Imperial College, London, United Kingdom. 32. Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, Donggu, Gwangju, South Korea. 33. Second Department of Internal Medicine, Nara Medical University, Nara, Japan. 34. Department of Pneumology, Faculty of Medicine in Hradec Kralove, Charles University in Prague and University Hospital Hradec Kralove, Hradec Kralove, Czech Republic. 35. Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. 36. The Hillingdon Hospital NHS Foundation Trust, United Kingdom; NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, United Kingdom. 37. Respiratory Franchise Medical, GlaxoSmithKline (GSK), London, United Kingdom. 38. Department of Pulmonary and Critical Care Medicine, Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 39. GlaxoSmithKline, King of Prussia, PA. 40. Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocio, Universidad de Sevilla, Sevilla, Spain; CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III, Madrid, Spain. 41. NIHR Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, United Kingdom. 42. University Hospital Osijek; Department of Internal Medicine; Faculty of Medicine, University J.J Strossmayer Osijek, Osijek, Croatia. 43. Hospital Clínico Universidad de Chile, Región Metropolitana, Chile. 44. Institute of Pneumology Marius Nasta, Bucharest, Romania. 45. Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan. 46. Department of Respiratory Medicine, Osaka Police Hospital, Osaka, Japan; Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. 47. Department of Medicine, Queen's University and Kingston General Hospital, Kingston, ON, Canada. 48. Federal University of Ceará-Brazil, Fortaleza, Brazil. 49. Observational and Pragmatic Research Institute, Singapore; University of Aberdeen, Aberdeen, United Kingdom. 50. Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. 51. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 52. Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Denmark. 53. Australian Respiratory and Sleep Medicine Institute, Flinders Medical Center, Adelaide, Australia. 54. Internal Medicine Department, Medical Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran. 55. University of Fortaleza/UNIFOR, Fortaleza, Brazil. 56. Department of Primary Care, Groningen Research Institute for Asthma and COPD, GRIAC, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands; Agia Barbara Health Care Center, Heraklion Crete, Greece. 57. Department of Chest Diseases, Faculty of Medicine, Selcuk University, Konya, Turkey. 58. Department of Thoracic Medicine, University Hospital of Heraklion, Medical School, University of Crete, Crete, Greece. 59. Pulmonary Research Institute at Lung Clinic Grosshansdorf, German Center for Lung Research, Grosshansdorf, Germany. 60. Department of Respiratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China. 61. Department of Research and Education, CIRO, Horn, The Netherlands; REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands.
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, postbronchodilator 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.
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, postbronchodilator 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.
Authors: Sara Souto-Miranda; Alex J van 't Hul; Anouk W Vaes; Jeanine C Antons; Remco S Djamin; Daisy J A Janssen; Frits M E Franssen; Alda Marques; Martijn A Spruit Journal: J Clin Med Date: 2022-06-26 Impact factor: 4.964
Authors: Jana Graf; Rudolf A Jörres; Tanja Lucke; Dennis Nowak; Claus F Vogelmeier; Joachim H Ficker Journal: Dtsch Arztebl Int Date: 2018-09-14 Impact factor: 5.594
Authors: Frits M E Franssen; Dionne E Smid; Dorly J H Deeg; Martijn Huisman; Jan Poppelaars; Emiel F M Wouters; Martijn A Spruit Journal: NPJ Prim Care Respir Med Date: 2018-08-10 Impact factor: 2.871
Authors: Eleonore H Koolen; Hieronymus W van Hees; Rob C van Lummel; Richard Dekhuijzen; Remco S Djamin; Martijn A Spruit; Alex J van 't Hul Journal: J Clin Med Date: 2019-03-11 Impact factor: 4.241
Authors: Norbert Königsdorfer; Rudolf A Jörres; Sandra Söhler; Tobias Welte; Jürgen Behr; Joachim H Ficker; Robert Bals; Henrik Watz; Johanna I Lutter; Tanja Lucke; Frank Biertz; Peter Alter; Claus F Vogelmeier; Kathrin Kahnert Journal: Patient Prefer Adherence Date: 2019-10-10 Impact factor: 2.711
Authors: Claus F Vogelmeier; Edward M Kerwin; Leif H Bjermer; Lee Tombs; Paul W Jones; Isabelle H Boucot; Ian P Naya; David A Lipson; Chris Compton; Neil Barnes; François Maltais Journal: Ther Adv Respir Dis Date: 2020 Jan-Dec Impact factor: 4.031
Authors: C Stridsman; J R Konradsen; L Vanfleteren; C Pedroletti; J Binnmyr; P Edfelt; K Fjällman Schärberg; Y Sjöö; F Nyberg; A Lindberg; A Tunsäter; A Ekberg-Jansson Journal: Eur Clin Respir J Date: 2020-10-23
Authors: Virginia Moya-Álvarez; Juan Luis Quevedo-Marín; Zichen Ji; Cristina Navarro-Jiménez; Rodrigo Jiménez-García; Ana López-de-Andrés; Alfonso Pérez-Trullén; Javier de Miguel-Díez Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-08-12
Authors: Sarah Houben-Wilke; Daisy J A Janssen; Frits M E Franssen; Lowie E G W Vanfleteren; Emiel F M Wouters; Martijn A Spruit Journal: Health Qual Life Outcomes Date: 2018-10-30 Impact factor: 3.186