Little agreement in GOLD category using CAT and mMRC in 450 primary care COPD patients in New Zealand.

Shaun Holt,Colin Helm,Davitt Sheahan,Andrew Corin,Chris Tofield,Janwillem W H Kocks

doi:10.1038/npjpcrm.2014.25

Abstract

Little agreement in GOLD category using CAT and mMRC in 450 primary care COPD patients in New Zealand.

Highlights

The updated 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines introduced a new method to categorise chronic obstructive pulmonary disease (COPD) patients according to risk and symptom level, whereas previously categorisation was based solely on lung function impairment.[1]
Symptom level can be assessed by using the modified Medical Research Council dyspnoea scale, the COPD Assessment Test (CAT) or the Clinical COPD Questionnaire (CCQ), the latter being added in the 2013 update.[2]
It has been suggested that this new method of COPD patient classification should not be used in primary care because it could lead to inappropriate management recommendations and the categorisation process itself is too complex.[3]

Summary

Introduction

The updated 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines introduced a new method to categorise chronic obstructive pulmonary disease (COPD) patients according to risk and symptom level, whereas previously categorisation was based solely on lung function impairment.[1]. It has been suggested that this new method of COPD patient classification should not be used in primary care because it could lead to inappropriate management recommendations and the categorisation process itself is too complex.[3] As there are different methods to assess symptoms, with all three having different constructs and measurement properties,[4] patients can fall into different categories according to the method used.[5] As a result, clinicians can get different treatment recommendations depending on which method they use to assess symptoms. We performed an audit of COPD patients in primary care to assess whether there were significant differences in GOLD category depending on whether the mMRC or the CAT were used, and to determine the appropriateness of the medications that these patients were prescribed, according to GOLD recommendations.

Results

Conclusion