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

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

Abstract

Background: The GOLD 2011 document proposed a new classification system for COPD combining symptom assessment by COPD assessment test (CAT) or modified Medical Research Council (mMRC) dyspnea scores, and exacerbation risk. We postulated that classification of COPD would be different by the symptom scale; CAT vs mMRC.

Methods: Outpatients with COPD were enrolled from January to June in 2012. The patients were categorized into A, B, C, and D according to the GOLD 2011; patients were categorized twice with mMRC and CAT score for symptom assessment, respectively. Additionally, correlations between mMRC scores and each item of CAT scores were analyzed.

Results: Classification of 257 patients using the CAT score vs mMRC scale was as follows. By using CAT score, 60 (23.3%) patients were assigned to group A, 55 (21.4%) to group B, 21 (8.2%) to group C, and 121 (47.1%) to group D. On the basis of the mMRC scale, 97 (37.7%) patients were assigned to group A, 18 (7.0%) to group B, 62 (24.1%) to group C, and 80 (31.1%) to group D. The kappa of agreement for the GOLD groups classified by CAT and mMRC was 0.510. The mMRC score displayed a wide range of correlation with each CAT item (r = 0.290 for sputum item to r = 0.731 for dyspnea item, p < 0.001).

Conclusions: The classification of COPD produced by the mMRC or CAT score was not identical. Care should be taken when stratifying COPD patients with one symptom scale versus another according to the GOLD 2011 document.

Figures

Figure 1
Figure 1
Consort diagram of the study participants. * Airflow obstruction was defined according to the GOLD criteria: a postbronchodilator FEV1/FVC (forced expiratory volume in 1s/forced vital capacity) ratio < 0.70.

References

    1. Vestbo J, Hurd SS, Agusti AG, Jones PW, Vogelmeier C, Anzueto A, Barnes PJ, Fabbri LM, Martinez FJ, Nishimura M. et al.Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med. 2013;187(4):347–365. doi: 10.1164/rccm.201204-0596PP.
    1. Garcia-Aymerich J, Serra Pons I, Mannino DM, Maas AK, Miller DP, Davis KJ. Lung function impairment, COPD hospitalisations and subsequent mortality. Thorax. 2011;66(7):585–590. doi: 10.1136/thx.2010.152876.
    1. Hurst JR, Vestbo J, Anzueto A, Locantore N, Mullerova H, Tal-Singer R, Miller B, Lomas DA, Agusti A, Macnee W. et al.Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128–1138. doi: 10.1056/NEJMoa0909883.
    1. Weatherall M, Marsh S, Shirtcliffe P, Williams M, Travers J, Beasley R. Quality of life measured by the St George’s Respiratory Questionnaire and spirometry. Eur Respir J. 2009;33(5):1025–1030. doi: 10.1183/09031936.00116808.
    1. Agusti A, Calverley PM, Celli B, Coxson HO, Edwards LD, Lomas DA, MacNee W, Miller BE, Rennard S, Silverman EK. et al.Characterisation of COPD heterogeneity in the ECLIPSE cohort. Respir Res. 2010;11:122.
    1. Papaioannou AI, Loukides S, Gourgoulianis KI, Kostikas K. Global assessment of the COPD patient: time to look beyond FEV1? Respir Med. 2009;103(5):650–660. doi: 10.1016/j.rmed.2009.01.001.
    1. 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):581–586. doi: 10.1136/thx.54.7.581.
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009;34(3):648–654. doi: 10.1183/09031936.00102509.
    1. Han MK, Muellerova H, Curran-Everett D, Dransfield MT, Washko GR, Regan EA, Bowler RP, Beaty TH, Hokanson JE, Lynch DA. et al.GOLD 2011 disease severity classification in COPDGene: a prospective cohort study. Lancet Respir Med. 2013;1(1):43–50. doi: 10.1016/S2213-2600(12)70044-9.
    1. Fletcher CM, Elmes PC, Fairbairn AS, Wood CH. The significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J. 1959;2(5147):257–266. doi: 10.1136/bmj.2.5147.257.
    1. Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J. 2007;29(6):1224–1238. doi: 10.1183/09031936.00109906.
    1. American Thoracic Society. Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med. 1995;152(3):1107–1136.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174. doi: 10.2307/2529310.
    1. Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JW, Karagiannis K, Siafakas N, Tzanakis N. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) BMC Pulm Med. 2012;12:20. doi: 10.1186/1471-2466-12-20.
    1. Kelly JL, Bamsey O, Smith C, Lord VM, Shrikrishna D, Jones PW, Polkey MI, Hopkinson NS. Health status assessment in routine clinical practice: the chronic obstructive pulmonary disease assessment test score in outpatients. Respiration. 2012;84(3):193–199. doi: 10.1159/000336549.
    1. Scichilone N, Chetta A. It’s Time to Let the ‘CAT’ out…Patient! Respiration. 2012;84(3):189–190. doi: 10.1159/000337272.
    1. Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, Perez T, Soler Cataluna JJ, van der Molen T, Adamek L. et al.Properties of the COPD assessment test in a cross-sectional European study. Eur Respir J. 2011;38(1):29–35. doi: 10.1183/09031936.00177210.
    1. Mackay AJ, Donaldson GC, Patel AR, Jones PW, Hurst JR, Wedzicha JA. Usefulness of the Chronic Obstructive Pulmonary Disease Assessment Test to evaluate severity of COPD exacerbations. Am J Respir Crit Care Med. 2012;185(11):1218–1224. doi: 10.1164/rccm.201110-1843OC.

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