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

Dionne E. Smid, Frits M.E. Franssen, Maria Gonik, Marc Miravitlles, Ciro Casanova, Borja G. Cosio, Pilar de Lucas-Ramos, Jose M. Marin, Cristina Martinez, Isabel Mir, Joan B. Soriano, Juan P. de Torres, Alvar Agusti, Nart B. Atalay, Julia Billington, Afroditi K. Boutou, Stefanie Brighenti-Zogg, Emma Chaplin, Samantha Coster, James W. DoddSelina Dürr, Alberto Fernandez-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 Joerres, Annika Karch, Julia L. Kelly, Yu-Il Kim, Hiroshi Kimura, Vladimir Koblizek, Janwillem H. Kocks, Samantha S.C. Kon, Namhee Kwon, Inês Ladeira, Sang-Do Lee, Joerg D. Leuppi, Nicholas Locantore, José L. Lopez-Campos, William D-C Man, Lana Maricic, Laura Mendoza, David Miedinger, Florin Mihaltan, Seigo Minami, Thys van der Molen, Trevor J. Murrells, Nienke Nakken, Yu Nishijima, Ian J. Norman, Barbora Novotna, Denis E. O'Donnell, Yoshitaka Ogata, Eanes D. Pereira, James Piercy, David Price, Chaicharn Pothirat, Natya Raghavan, Thomas Ringbaek, Dimitar Sajkov, Naseh Sigari, Sally Singh, Mark Small, Guilherme F. da Silva, Rebecca J. Tanner, Ioanna G. Tsiligianni, Baykal Tulek, Nikolaos Tzanakis, Lowie E.G.W. Vanfleteren, Henrik Watz, Katherine A. Webb, Emiel F.M. Wouters, Guogang G. Xie, Masanori Yoshikawa, Martijn A. Spruit

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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.
Original languageEnglish
Pages (from-to)1097.e11-1097.e24
Number of pages24
JournalJournal of the American Medical Directors Association
Volume18
Issue number12
Early online date20 Nov 2017
DOIs
Publication statusPublished - 1 Dec 2017

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Chronic Obstructive Pulmonary Disease
Calibration
Biomedical Research
Spirometry
Disease Management
ROC Curve
Dyspnea
Surveys and Questionnaires
Prospective Studies

Keywords

  • COPD
  • GOLD
  • health status
  • clinical significance

Cite this

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. / Smid, Dionne E.; Franssen, Frits M.E.; Gonik, Maria; Miravitlles, Marc; Casanova, Ciro; Cosio, Borja G.; de Lucas-Ramos, Pilar; Marin, Jose M.; Martinez, Cristina; Mir, Isabel; Soriano, Joan B.; de Torres, Juan P.; Agusti, Alvar; Atalay, Nart B.; Billington, Julia; Boutou, Afroditi K.; Brighenti-Zogg, Stefanie; Chaplin, Emma; Coster, Samantha; Dodd, James W.; Dürr, Selina; Fernandez-Villar, Alberto; Groenen, Miriam T.J.; Guimarães, Miguel; Hejduk, Karel; Higgins, Victoria; Hopkinson, Nicholas S.; Horita, Nobuyuki; Houben-Wilke, Sarah; Janssen, Daisy J.A.; Jehn, Melissa; Joerres, Rudolf; Karch, Annika; Kelly, Julia L.; Kim, Yu-Il; Kimura, Hiroshi; Koblizek, Vladimir; Kocks, Janwillem H.; Kon, Samantha S.C.; Kwon, Namhee; Ladeira, Inês; Lee, Sang-Do; Leuppi, Joerg D.; Locantore, Nicholas; Lopez-Campos, José L.; D-C Man, William; Maricic, Lana; Mendoza, Laura; Miedinger, David; Mihaltan, Florin; Minami, Seigo; van der Molen, Thys; Murrells, Trevor J.; Nakken, Nienke; Nishijima, Yu; Norman, Ian J.; Novotna, Barbora; O'Donnell, Denis E.; Ogata, Yoshitaka; Pereira, Eanes D.; Piercy, James; Price, David; Pothirat, Chaicharn; Raghavan, Natya; Ringbaek, Thomas; Sajkov, Dimitar; Sigari, Naseh; Singh, Sally; Small, Mark; da Silva, Guilherme F.; Tanner, Rebecca J.; Tsiligianni, Ioanna G.; Tulek, Baykal; Tzanakis, Nikolaos; Vanfleteren, Lowie E.G.W.; Watz, Henrik; Webb, Katherine A.; Wouters, Emiel F.M.; Xie, Guogang G.; Yoshikawa, Masanori; Spruit, Martijn A.

In: Journal of the American Medical Directors Association, Vol. 18, No. 12, 01.12.2017, p. 1097.e11-1097.e24.

Research output: Contribution to journalArticle

Smid, DE, Franssen, FME, Gonik, M, Miravitlles, M, Casanova, C, Cosio, BG, de Lucas-Ramos, P, Marin, JM, Martinez, C, Mir, I, Soriano, JB, de Torres, JP, Agusti, A, Atalay, NB, Billington, J, Boutou, AK, Brighenti-Zogg, S, Chaplin, E, Coster, S, Dodd, JW, Dürr, S, Fernandez-Villar, A, Groenen, MTJ, Guimarães, M, Hejduk, K, Higgins, V, Hopkinson, NS, Horita, N, Houben-Wilke, S, Janssen, DJA, Jehn, M, Joerres, R, Karch, A, Kelly, JL, Kim, Y-I, Kimura, H, Koblizek, V, Kocks, JH, Kon, SSC, Kwon, N, Ladeira, I, Lee, S-D, Leuppi, JD, Locantore, N, Lopez-Campos, JL, D-C Man, W, Maricic, L, Mendoza, L, Miedinger, D, Mihaltan, F, Minami, S, van der Molen, T, Murrells, TJ, Nakken, N, Nishijima, Y, Norman, IJ, Novotna, B, O'Donnell, DE, Ogata, Y, Pereira, ED, Piercy, J, Price, D, Pothirat, C, Raghavan, N, Ringbaek, T, Sajkov, D, Sigari, N, Singh, S, Small, M, da Silva, GF, Tanner, RJ, Tsiligianni, IG, Tulek, B, Tzanakis, N, Vanfleteren, LEGW, Watz, H, Webb, KA, Wouters, EFM, Xie, GG, Yoshikawa, M & Spruit, MA 2017, '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', Journal of the American Medical Directors Association, vol. 18, no. 12, pp. 1097.e11-1097.e24. https://doi.org/10.1016/j.jamda.2017.09.003
Smid, Dionne E. ; Franssen, Frits M.E. ; Gonik, Maria ; Miravitlles, Marc ; Casanova, Ciro ; Cosio, Borja G. ; de Lucas-Ramos, Pilar ; Marin, Jose M. ; Martinez, Cristina ; Mir, Isabel ; Soriano, Joan B. ; de Torres, Juan P. ; Agusti, Alvar ; Atalay, Nart B. ; Billington, Julia ; Boutou, Afroditi K. ; Brighenti-Zogg, Stefanie ; Chaplin, Emma ; Coster, Samantha ; Dodd, James W. ; Dürr, Selina ; Fernandez-Villar, Alberto ; Groenen, Miriam T.J. ; Guimarães, Miguel ; Hejduk, Karel ; Higgins, Victoria ; Hopkinson, Nicholas S. ; Horita, Nobuyuki ; Houben-Wilke, Sarah ; Janssen, Daisy J.A. ; Jehn, Melissa ; Joerres, Rudolf ; Karch, Annika ; Kelly, Julia L. ; Kim, Yu-Il ; Kimura, Hiroshi ; Koblizek, Vladimir ; Kocks, Janwillem H. ; Kon, Samantha S.C. ; Kwon, Namhee ; Ladeira, Inês ; Lee, Sang-Do ; Leuppi, Joerg D. ; Locantore, Nicholas ; Lopez-Campos, José L. ; D-C Man, William ; Maricic, Lana ; Mendoza, Laura ; Miedinger, David ; Mihaltan, Florin ; Minami, Seigo ; van der Molen, Thys ; Murrells, Trevor J. ; Nakken, Nienke ; Nishijima, Yu ; Norman, Ian J. ; Novotna, Barbora ; O'Donnell, Denis E. ; Ogata, Yoshitaka ; Pereira, Eanes D. ; Piercy, James ; Price, David ; Pothirat, Chaicharn ; Raghavan, Natya ; Ringbaek, Thomas ; Sajkov, Dimitar ; Sigari, Naseh ; Singh, Sally ; Small, Mark ; da Silva, Guilherme F. ; Tanner, Rebecca J. ; Tsiligianni, Ioanna G. ; Tulek, Baykal ; Tzanakis, Nikolaos ; Vanfleteren, Lowie E.G.W. ; Watz, Henrik ; Webb, Katherine A. ; Wouters, Emiel F.M. ; Xie, Guogang G. ; Yoshikawa, Masanori ; Spruit, Martijn A. / 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. In: Journal of the American Medical Directors Association. 2017 ; Vol. 18, No. 12. pp. 1097.e11-1097.e24.
@article{68e4b59f30c941e781ca4f386e6c45bc,
title = "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",
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.",
keywords = "COPD, GOLD, health status, clinical significance",
author = "Smid, {Dionne E.} and Franssen, {Frits M.E.} and Maria Gonik and Marc Miravitlles and Ciro Casanova and Cosio, {Borja G.} and {de Lucas-Ramos}, Pilar and Marin, {Jose M.} and Cristina Martinez and Isabel Mir and Soriano, {Joan B.} and {de Torres}, {Juan P.} and Alvar Agusti and Atalay, {Nart B.} and Julia Billington and Boutou, {Afroditi K.} and Stefanie Brighenti-Zogg and Emma Chaplin and Samantha Coster and Dodd, {James W.} and Selina D{\"u}rr and Alberto Fernandez-Villar and Groenen, {Miriam T.J.} and Miguel Guimar{\~a}es and Karel Hejduk and Victoria Higgins and Hopkinson, {Nicholas S.} and Nobuyuki Horita and Sarah Houben-Wilke and Janssen, {Daisy J.A.} and Melissa Jehn and Rudolf Joerres and Annika Karch and Kelly, {Julia L.} and Yu-Il Kim and Hiroshi Kimura and Vladimir Koblizek and Kocks, {Janwillem H.} and Kon, {Samantha S.C.} and Namhee Kwon and In{\^e}s Ladeira and Sang-Do Lee and Leuppi, {Joerg D.} and Nicholas Locantore and Lopez-Campos, {Jos{\'e} L.} and {D-C Man}, William and Lana Maricic and Laura Mendoza and David Miedinger and Florin Mihaltan and Seigo Minami and {van der Molen}, Thys and Murrells, {Trevor J.} and Nienke Nakken and Yu Nishijima and Norman, {Ian J.} and Barbora Novotna and O'Donnell, {Denis E.} and Yoshitaka Ogata and Pereira, {Eanes D.} and James Piercy and David Price and Chaicharn Pothirat and Natya Raghavan and Thomas Ringbaek and Dimitar Sajkov and Naseh Sigari and Sally Singh and Mark Small and {da Silva}, {Guilherme F.} and Tanner, {Rebecca J.} and Tsiligianni, {Ioanna G.} and Baykal Tulek and Nikolaos Tzanakis and Vanfleteren, {Lowie E.G.W.} and Henrik Watz and Webb, {Katherine A.} and Wouters, {Emiel F.M.} and Xie, {Guogang G.} and Masanori Yoshikawa and Spruit, {Martijn A.}",
note = "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 study.",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.jamda.2017.09.003",
language = "English",
volume = "18",
pages = "1097.e11--1097.e24",
journal = "Journal of the American Medical Directors Association",
issn = "1525-8610",
publisher = "Elsevier",
number = "12",

}

TY - JOUR

T1 - 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

AU - Smid, Dionne E.

AU - Franssen, Frits M.E.

AU - Gonik, Maria

AU - Miravitlles, Marc

AU - Casanova, Ciro

AU - Cosio, Borja G.

AU - de Lucas-Ramos, Pilar

AU - Marin, Jose M.

AU - Martinez, Cristina

AU - Mir, Isabel

AU - Soriano, Joan B.

AU - de Torres, Juan P.

AU - Agusti, Alvar

AU - Atalay, Nart B.

AU - Billington, Julia

AU - Boutou, Afroditi K.

AU - Brighenti-Zogg, Stefanie

AU - Chaplin, Emma

AU - Coster, Samantha

AU - Dodd, James W.

AU - Dürr, Selina

AU - Fernandez-Villar, Alberto

AU - Groenen, Miriam T.J.

AU - Guimarães, Miguel

AU - Hejduk, Karel

AU - Higgins, Victoria

AU - Hopkinson, Nicholas S.

AU - Horita, Nobuyuki

AU - Houben-Wilke, Sarah

AU - Janssen, Daisy J.A.

AU - Jehn, Melissa

AU - Joerres, Rudolf

AU - Karch, Annika

AU - Kelly, Julia L.

AU - Kim, Yu-Il

AU - Kimura, Hiroshi

AU - Koblizek, Vladimir

AU - Kocks, Janwillem H.

AU - Kon, Samantha S.C.

AU - Kwon, Namhee

AU - Ladeira, Inês

AU - Lee, Sang-Do

AU - Leuppi, Joerg D.

AU - Locantore, Nicholas

AU - Lopez-Campos, José L.

AU - D-C Man, William

AU - Maricic, Lana

AU - Mendoza, Laura

AU - Miedinger, David

AU - Mihaltan, Florin

AU - Minami, Seigo

AU - van der Molen, Thys

AU - Murrells, Trevor J.

AU - Nakken, Nienke

AU - Nishijima, Yu

AU - Norman, Ian J.

AU - Novotna, Barbora

AU - O'Donnell, Denis E.

AU - Ogata, Yoshitaka

AU - Pereira, Eanes D.

AU - Piercy, James

AU - Price, David

AU - Pothirat, Chaicharn

AU - Raghavan, Natya

AU - Ringbaek, Thomas

AU - Sajkov, Dimitar

AU - Sigari, Naseh

AU - Singh, Sally

AU - Small, Mark

AU - da Silva, Guilherme F.

AU - Tanner, Rebecca J.

AU - Tsiligianni, Ioanna G.

AU - Tulek, Baykal

AU - Tzanakis, Nikolaos

AU - Vanfleteren, Lowie E.G.W.

AU - Watz, Henrik

AU - Webb, Katherine A.

AU - Wouters, Emiel F.M.

AU - Xie, Guogang G.

AU - Yoshikawa, Masanori

AU - Spruit, Martijn A.

N1 - 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 study.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - 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.

AB - 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.

KW - COPD

KW - GOLD

KW - health status

KW - clinical significance

U2 - 10.1016/j.jamda.2017.09.003

DO - 10.1016/j.jamda.2017.09.003

M3 - Article

VL - 18

SP - 1097.e11-1097.e24

JO - Journal of the American Medical Directors Association

JF - Journal of the American Medical Directors Association

SN - 1525-8610

IS - 12

ER -