Abstract
BackgroundThe 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.MethodsOutpatients 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.ResultsClassification 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).ConclusionsThe 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.
Highlights
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 document proposed a new classification system for Chronic obstructive pulmonary disease (COPD) combining symptom assessment by COPD assessment test (CAT) or modified Medical Research Council dyspnea scores, and exacerbation risk
Among 257 COPD patients, using modified Medical Research Council (mMRC) scale (Table 2), 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; on the basis of the CAT score (Table 3), 60 (23.3%) patients were assigned to group A, 55 (21.4%) to group B, 21 (8.2%) to
A main finding of this study was that the group classification of COPD produced by each symptom scale was not identical because the distributions of CAT scores were heterogeneous at every mMRC level
Summary
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. The CAT comprises eight items relating to the severity of cough, sputum, dyspnea, chest tightness, capacity for exercise and activities, confidence, sleep quality and energy levels [8] while mMRC scale is a quantitative assessment tool only for breathlessness. These questionnaires are used to distinguish patients with less severe symptoms from patients with more severe symptoms; low vs high symptoms in the new GOLD 2011. The group assignment of COPD patients by mMRC vs SGRQ was not identical [9]
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