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

BMC Pulmonary Medicine

Sung-Chul Lim¹  Young-Chul Kim¹  Kyu-Sik Kim¹  In-Jae Oh¹  Yong-Soo Kwon¹  Hee-Jung Ban¹  Yu-Il Kim¹  Jisun Oh¹  Sunmin Kim¹ 

[1] Division of Pulmonology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, 501-757, South Korea

关键词: mMRC scores;    CAT;    COPD;   

Others  :  1122327
DOI  :  10.1186/1471-2466-13-35

 received in 2013-01-23, accepted in 2013-05-29,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [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.
• [2]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.
• [3]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.
• [4]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.
• [5]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.
• [6]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.
• [7]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.
• [8]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.
• [9]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.
• [10]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.
• [11]Celli BR, Barnes PJ: Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007, 29(6):1224-1238.
• [12]American Thoracic Society: Standardization of Spirometry, 1994 Update. Am J Respir Crit Care Med 1995, 152(3):1107-1136.
• [13]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33(1):159-174.
• [14]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. BioMed Central Full Text
• [15]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.
• [16]Scichilone N, Chetta A: It’s Time to Let the ‘CAT’ out…Patient! Respiration 2012, 84(3):189-190.
• [17]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.
• [18]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.