Differential Effect of Modified Medical Research Council Dyspnea, COPD Assessment Test, and Clinical COPD Questionnaire for Symptoms Evaluation Within the New GOLD Staging and Mortality in COPD

Casanova, Ciro; Marı́n, José Marı́a; Martínez-González, Cristina; Lucas-Ramos, Pilar de; Mir-Viladrich, Isabel; Cosío, Borja G.; Peces-Barba, Germán; Solanes-García, Ingrid; Agüero, Ramón; Feu-Collado, Nuria; Rubio, Myriam Calle; Alfageme, Inmaculada; Diego-Damia, Alfredo de; Irigaray, Rosa; Marín, Marta; Balcells, Eva; Llunell, Antonia; Gáldiz, Juan B.; Golpe, Rafael; Lacarcel, Celia; Cruchaga, Carlos; Marín, Alicia; Soriano, Joan B.; Lόpez-Campos, José Luís; Soler-Cataluña, Juan José; de-Torres, Juan P.

doi:10.1378/chest.14-2449

Cited by 101 publications

(97 citation statements)

References 24 publications

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“…In clinical practice, CAT is able to distinguish among patients with exacerbation of COPD [37], patients with different degrees of severity [37], and patients with associated comorbidities [37]. Moreover, CAT has demonstrated its validity as a prognostic measure [38,39]. In the present study, we found a close relationship between SAD and CAT (Fig.…”

Section: Discussionsupporting

confidence: 66%

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

et al. 2016

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Background: In chronic obstructive pulmonary disease (COPD) patients, small-airway dysfunction (SAD) is considered a functional hallmark of disease. However, the exact role of SAD in the clinical presentation of COPD is not yet completely understood; moreover, it is not known whether SAD may have a relationship with the impact of disease. Objectives: To evaluate the prevalence of SAD among COPD patients categorized by the old and the new GOLD classification and to ascertain whether there is a relationship between SAD and impact of disease measured by the COPD Assessment Test (CAT) questionnaire. Methods: We prospectively enrolled COPD outpatients from the University Hospital of Parma. Using the impulse oscillometry system (IOS), we assessed the fall in resistance from 5 to 20 Hz (R5-R20), reactance at 5 Hz (X5), and resonant frequency (F_Res) as markers of peripheral airway dysfunction. According to R5-R20 ≥0.07 or <0.07, the cohort was also categorized in patients with and without SAD, respectively. Results: We studied 202 patients. In both GOLD classifications, a progressive increasing distribution of R5-R20 and F_Res was reported with a decreasing of X5. Moreover, there was a significant correlation between R5-R20 and CAT (r = 0.527, p < 0.001). Finally, the presence of SAD (OR 11.96; 95% CI 4.53-31.58; p < 0.001) and use of ICS + LABA + LAMA (OR 5.31; 95% CI 1.88-15.02; p = 0.002) were independent predictors of higher impact (CAT score ≥10). Conclusion: In COPD patients, the presence of SAD, as assessed by IOS, progressively increases with GOLD classifications and it is closely related to the high impact of disease on health status.

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Section: Discussionsupporting

confidence: 66%

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

et al. 2016

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“…Dyspnea grade is also closely linked to risk for exacerbations (20), and severity of dyspnea is a significant predictor of mortality in patients with COPD (77). LABA/LAMA combinations have that it is associated with exacerbation frequency in patients with COPD (83).…”

Section: Impact Of β 2 Adrenoceptor Agonist On Mucociliary Clearancementioning

confidence: 99%

How Do Dual Long-Acting Bronchodilators Prevent Exacerbations of Chronic Obstructive Pulmonary Disease?

Beeh

Burgel

Franssen³

et al. 2017

Am J Respir Crit Care Med

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Word Count: 187 At-a-Glance CommentaryResults from multiple clinical trials have demonstrated that fixed combinations of long-acting β-adrenergic agonists (LABA) and long-acting muscarinic antagonists (LAMA) are significantly superior to their monocomponents and to the combination LABA and an inhaled corticosteroid in decreasing the frequency of exacerbations in patients with chronic obstructive pulmonary disease. At present, the mechanism(s) underlying this clinical benefit are not fully understood.This review considers potential mechanisms whereby LABA/LAMA combinations might exert additive or synergistic effects that lead to a decrease in exacerbations. Mechanisms considered include effects on lung hyperinflation and mechanical stress, inflammation, excessive mucus production with impaired mucociliary clearance, and symptom severity and variability. Word count: 188

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“…Breathlessness is measured using the modified Medical Research Council (mMRC) dyspnea scale,3 is strongly associated with impaired health-related quality of life,4,5 shorter survival,6,7 and predicts mortality even stronger than measures of health status7 and lung function6 in COPD. According to the current Global Initiative of Obstructive Lung Disease (GOLD) recommendations, breathlessness is an important factor for assessing disease severity and a major target for pharmacological and non-pharmacological treatment of COPD 1.…”

Section: Introductionmentioning

confidence: 99%

“…Disabling breathlessness is commonly defined as an mMRC score of ≥2,1 which means having breathlessness when walking slower than others or stopping when walking at own pace on level ground, stopping every 100 m or after a few minutes, or being too breathless to leave the house or being breathless on washing or dressing. An mMRC cut-off score of ≥2 has been found to be optimal for prediction of increased mortality7 and is used in the current GOLD severity classification of COPD 1…”

Section: Introductionmentioning

confidence: 99%

Persistent disabling breathlessness in chronic obstructive pulmonary disease

Sundh¹,

Ekström²

2016

COPD

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ObjectiveTo determine the prevalence, change in breathlessness status over time, and risk factors for disabling and persistent disabling breathlessness in relation to treatments in chronic obstructive pulmonary disease (COPD).Materials and methodsLongitudinal analysis of data from the Swedish National Register of COPD with breathlessness measured using modified Medical Research Council (mMRC) scores at two subsequent visits. Prevalence of disabling breathlessness (mMRC ≥2 at baseline) and persistent disabling breathlessness (disabling breathlessness at baseline and follow-up) was investigated in relation to COPD treatment. Risk factors for disabling breathlessness, change from non-disabling to disabling breathlessness, and persistent disabling breathlessness were analyzed using multiple logistic regression.ResultsA total of 1,689 patients were included in the study with a median follow-up of 12 months (interquartile range: 4 months). Prevalence of disabling breathlessness was 54% at baseline. Persistent disabling breathlessness was present in 43% of patients despite treatment and in 74% of patients despite combined inhaled triple therapy and physiotherapy. Risk factors for disabling breathlessness or change to disabling breathlessness were higher age, lower lung function, frequent exacerbations, obesity, heart failure, depression, and hypoxic respiratory failure (all P<0.05). Persistent disabling breathlessness was associated with lower lung function and ischemic heart disease (all P<0.05).ConclusionDisabling breathlessness is common in COPD despite treatment, which calls for improved symptomatic treatments and consideration of factors influencing disabling breathlessness. Factors influencing disabling breathlessness should be considered for COPD management.

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Differential Effect of Modified Medical Research Council Dyspnea, COPD Assessment Test, and Clinical COPD Questionnaire for Symptoms Evaluation Within the New GOLD Staging and Mortality in COPD

Cited by 101 publications

References 24 publications

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

Prevalence of Small-Airway Dysfunction among COPD Patients with Different GOLD Stages and Its Role in the Impact of Disease

How Do Dual Long-Acting Bronchodilators Prevent Exacerbations of Chronic Obstructive Pulmonary Disease?

Persistent disabling breathlessness in chronic obstructive pulmonary disease

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