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      Respiratory symptoms (COPD Assessment Test and modified Medical Research Council dyspnea scores) and GOLD-ABCD COPD classification: the LASSYC study Translated title: Sintomas respiratórios (Teste de Avaliação da DPOC e pontuação modificada de dispneia do Conselho de Pesquisa Médica) e classificação GOLD-ABCD COPD: o estudo LASSYC

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          Abstract

          ABSTRACT Objective To assess the frequency and severity of 24-hour respiratory symptoms according to COPD GOLD-ABCD classification (2017-version), the distribution of the patients with COPD into GOLD categories using mMRC (≥2) or CAT (≥10) scores, and agreement between these cut-off points. Methods In this cross-sectional study (LASSYC study), 24-hour day respiratory symptoms were assessed by the Evaluating Respiratory Symptoms in COPD (E-RS) questionnaire, Nighttime Symptoms of COPD Instrument (NiSCI), Early Morning Symptoms of COPD Instrument (EMSCI), CAT and mMRC scores. Results Among the 734 patients with COPD, 61% were male, age 69.6±8.7 years, FEV1% post-BD 49.1±17.5%, mMRC 1.8±1.0 and CAT 15.3±.8.1. By mMRC 33.7% were group-A, 29.2% group-B, 10.2% group-C and 26.9% group-D. By CAT 22.3% were group-A, 41% group-B, 4.8% group-C and 31.9% group-D. Using the mMRC the severity of E-RS, NiSCI and EMSCI scores increased from group A to D. Using the CAT, the groups B and D had the higher scores. Agreement between mMRC and CAT was 89.5% (Kappa statistics=75.7%). For mMRC score of 2, CAT score of ≥11 showed the maximum Youden’s index (1.34). For mMRC score of 1, CAT score of ≥9 and ≥10 showed the maximum Youden’s index (1.48). Conclusion GOLD COPD classification by CAT seems to better discriminate 24-hour symptoms. Results do not support the equivalent use of CAT≥10 and mMRC≥2 for assessing symptoms.

          Translated abstract

          RESUMO Objetivo Avaliar a frequência e gravidade dos sintomas respiratórios de 24 horas de acordo com a classificação COPD GOLD-ABCD (versão 2017), a distribuição dos pacientes com DPOC nas categorias GOLD usando escores mMRC (≥2) ou CAT (≥10) e concordância entre esses pontos de corte. Métodos Neste estudo transversal (estudo LASSYC), os sintomas respiratórios diários de 24 horas foram avaliados pelo questionário Avaliando os Sintomas Respiratórios em DPOC (Evaluating Respiratory Symptoms - E-RS), Instrumento de Sintomas Noturnos de DPOC (Nighttime Symptoms of COPD Instrument -NiSCI), Instrumento de Sintomas Matinais de DPOC (Early Morning Symptoms of COPD Instrument - EMSCI), pontuações CAT e mMRC. Resultados Entre os 734 pacientes com DPOC, 61% eram do sexo masculino, idade 69,6 ± 8,7 anos, VEF1% pós-BD 49,1 ± 17,5%, mMRC 1,8 ± 1,0 e CAT 15,3 ± 0,8,1. Por mMRC 33,7% eram do grupo A, 29,2% do grupo B, 10,2% do grupo C e 26,9% do grupo D. Por CAT, 22,3% eram do grupo A, 41% do grupo B, 4,8% do grupo C e 31,9% do grupo D. Usando o mMRC, a gravidade dos escores E-RS, NiSCI e EMSCI aumentou do grupo A para D. Usando o CAT, os grupos B e D tiveram os escores mais altos. A concordância entre mMRC e CAT foi de 89,5% (estatística Kappa = 75,7%). Para a pontuação mMRC de 2, a pontuação CAT ≥11 mostrou o índice de Youden máximo (1,34). Para a pontuação mMRC de 1, a pontuação CAT ≥9 e ≥10 mostrou o índice de Youden máximo (1,48). Conclusão A classificação GOLD COPD por CAT parece discriminar melhor os sintomas de 24 horas. Os resultados não suportam o uso equivalente de CAT≥10 e mMRC≥2 para avaliação dos sintomas.

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          Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary

          American Journal of Respiratory and Critical Care Medicine, 195(5), 557-582
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            Development and first validation of the COPD Assessment Test.

            There is need for a validated short, simple instrument to quantify chronic obstructive pulmonary disease (COPD) impact in routine practice to aid health status assessment and communication between patient and physician. Current health-related quality of life questionnaires provide valid assessment of COPD, but are complex, which limits routine use. The aim of the present study was to develop a short validated patient-completed questionnaire, the COPD Assessment Test (CAT), assessing the impact of COPD on health status. 21 candidate items identified through qualitative research with COPD patients were used in three prospective international studies (Europe and the USA, n = 1,503). Psychometric and Rasch analyses identified eight items fitting a unidimensional model to form the CAT. Items were tested for differential functioning between countries. Internal consistency was excellent: Cronbach's alpha = 0.88. Test re-test in stable patients (n = 53) was very good (intra-class correlation coefficient 0.8). In the sample from the USA, the correlation with the COPD-specific version of the St George's Respiratory Questionnaire was r = 0.80. The difference between stable (n = 229) and exacerbation patients (n = 67) was five units of the 40-point scale (12%; p<0.0001). The CAT is a short, simple questionnaire for assessing and monitoring COPD. It has good measurement properties, is sensitive to differences in state and should provide a valid, reliable and standardised measure of COPD health status with worldwide relevance.
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              Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease.

              Methods of classifying chronic obstructive pulmonary disease (COPD) depend largely upon spirometric measurements but disability is only weakly related to measurements of lung function. With the increased use of pulmonary rehabilitation, a need has been identified for a simple and standardised method of categorising disability in COPD. This study examined the validity of the Medical Research Council (MRC) dyspnoea scale for this purpose. One hundred patients with COPD were recruited from an outpatient pulmonary rehabilitation programme. Assessments included the MRC dyspnoea scale, spirometric tests, blood gas tensions, a shuttle walking test, and Borg scores for perceived breathlessness before and after exercise. Health status was assessed using the St George's Respiratory Questionnaire (SGRQ) and Chronic Respiratory Questionnaire (CRQ). The Nottingham Extended Activities of Daily Living (EADL) score and Hospital Anxiety and Depression (HAD) score were also measured. Of the patients studied, 32 were classified as having MRC grade 3 dyspnoea, 34 MRC grade 4 dyspnoea, and 34 MRC grade 5 dyspnoea. Patients with MRC grades 1 and 2 dyspnoea were not included in the study. There was a significant association between MRC grade and shuttle distance, SGRQ and CRQ scores, mood state and EADL. Forced expiratory volume in one second (FEV1) was not associated with MRC grade. Multiple logistic regression showed that the determinants of disability appeared to vary with the level of disability. Between MRC grades 3 and 4 the significant covariates were exercise performance, SGRQ and depression score, whilst between grades 4 and 5 exercise performance and age were the major determinants. The MRC dyspnoea scale is a simple and valid method of categorising patients with COPD in terms of their disability that could be used to complement FEV1 in the classification of COPD severity.
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                Author and article information

                Journal
                jbpneu
                Jornal Brasileiro de Pneumologia
                J. bras. pneumol.
                Sociedade Brasileira de Pneumologia e Tisiologia (São Paulo, SP, Brazil )
                1806-3756
                2021
                : 47
                : 5
                : e20210156
                Affiliations
                [04] orgnameAstraZeneca Costa Rica
                [05] Barcelona orgnameCIBER de Enfermedades Respiratorias orgdiv1Vall d’Hebron Research Institute orgdiv2Hospital Universitari Vall d'Hebron Spain
                [03] Pelotas RS orgnameFederal University of Pelotas orgdiv1Post-Graduate Program in Epidemiology Brasil
                [02] Montevideo orgnameUniversidad de la República Uruguay
                [01] Caracas orgnameUniversidad Central de Venezuela Venezuela
                Article
                S1806-37132021000500205 S1806-3713(21)04700500205
                10.36416/1806-3756/e20210156
                34787288
                1ed07b2b-e8e2-42f3-a224-d8e07b101a53

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 28 July 2021
                : 16 April 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 40, Pages: 0
                Product

                SciELO Brazil

                Categories
                Original Article

                Chronic obstructive pulmonary disease,Sintomas e DPOC,Doença pulmonar obstrutiva crônica,Symptoms and COPD

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