Produção Nacional
Revisado por pares
Redefining 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
2017; Elsevier BV; Volume: 18; Issue: 12 Linguagem: Inglês
10.1016/j.jamda.2017.09.003
ISSN1538-9375
AutoresDionne E. Smid, Frits M.E. Franssen, Maria Gonik, Marc Miravitlles, Ciro Casanova, Borja G. Cosío, Pilar de Lucas‐Ramos, José M. Marı́n, Cristina Martínez González, Isabel Mir, Joan B. Soriano, Juan P. de‐Torres, Àlvar Agustí, Nart Bedin Atalay, Julia Billington, Afroditi Boutou, Stefanie Brighenti-Zogg, Emma Chaplin, Samantha Coster, James Dodd, Selina Dürr, Alberto Fernández‐Villar, Miriam T.J. Groenen, Miguel Guimarães, Karel Hejduk, Victoria Higgins, Nicholas S Hopkinson, Nobuyuki Horita, Sarah Houben‐Wilke, Daisy J.A. Janssen, Melissa Jehn, Rudolf A. Joerres, Annika Karch, Julia L. Kelly, Yu‐Il Kim, Hiroshi Kimura, Vladimír Koblížek, Janwillem Kocks, Samantha S.C. Kon, Namhee Kwon, Inês Ladeira, Sang‐Do Lee, Jörg D. Leuppi, Nicholas Locantore, José Luís López-Campos, William D‐C Man, Lana Maričić, Laura Mendoza, David Miedinger, Florin Mihălţan, Seigo Minami, Thys van der Molen, Trevor Murrells, Nienke Nakken, Yu Nishijima, Ian Norman, Barbora Novotná, Denis E. O’Donnell, Yoshitaka Ogata, Eanes Delgado Barros Pereira, James Piercy, David Price, Chaicharn Pothirat, Natya Raghavan, Thomas Ringbæk, Dimitar Sajkov, Naseh Sigari, Sally Singh, Mark Small, Guilherme Silva, Rebecca Tanner, Ioanna Tsiligianni, Baykal Tülek, Νikolaos Tzanakis, Lowie E.G.W. Vanfleteren, Henrik Watz, Katherine A. Webb, Emiel F.�M. Wouters, Guogang Xie, Masanori Yoshikawa, Martijn A. Spruit,
Tópico(s)Respiratory Support and Mechanisms
ResumoBackground 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.
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