Variation in Assignment of the COPD Patients into a GOLD Group According to Symptoms Severity.
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2020
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International Journal of Chronic Obstructive Pulmonary Disease
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Abstract
Introduction: The Global Organization of Lung Disease (GOLD) classifies patients with
chronic obstructive pulmonary disease (COPD) taking into account the symptoms. The
modified Medical Research Council’s dyspnea scale (mMRC) and the COPD assessment
test (CAT) are used to assess these symptoms. In this study, we analyze the concordance of
GOLD classification using mMRC and CAT.
Patients and Methods: This is an observational study of a cohort of 169 patients with
COPD, who were classified following the GOLD 2017 recommendations, using both mMRC
and CAT. A concordance analysis was applied, and a ROC curve was generated to identify
the CAT score that best concorded with the mMRC scale.
Results: The concordance for the GOLD groups classified by CAT and mMRC was
moderate (kappa 0.492). For mMRC score of 1 and 2, a CAT score of ≥9 and ≥16 showed
the maximum value of the Youden index, respectively. By reclassifying the patients with the
new cut-off points obtained, the best concordance was obtained between the cut-off point for
CAT of 16 and for mMRC of 2, followed by CAT of 9 and mMRC of 1.
Conclusion: Because of the deficient concordance between CAT and mMRC, we propose
the use of new cut-off points in future updates of the GOLD strategy.
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Keywords
Chronic obstructive pulmonary disease, Global Organization of Lung Disease, Dyspnea, Modified Medical Research Council, COPD assessment test