0
Original Research: COPD |

Global Initiative for Chronic Obstructive Lung Disease 2011 Symptom/Risk Assessment in α1-Antitrypsin DeficiencyNew GOLD Strategy

Anilkumar P. Pillai, MBBS; Alice M. Turner, PhD; Robert A. Stockley, MD
Author and Funding Information

From the University Hospitals, Birmingham (Drs Pillai and Stockley); the University of Birmingham (Dr Turner); and the Heart of England NHS Foundation Trust (Dr Turner), Birmingham, England.

Correspondence to: Alice M. Turner, PhD, Queen Elizabeth Hospital Research Laboratories, Mindelsohn Way, Birmingham, B15 2WB, England; e-mail: a.m.wood@bham.ac.uk


Abstracts were presented as posters at the European Respiratory Society meeting, Vienna, Austria, September 2012 and the British Thoracic Society meeting, London, England, December 2012.

Drs Turner and Stockley are joint senior authors of this paper.

Funding/Support: Dr Stockley receives research funding from European Union Seventh Framework Programme (FP7) fund and Medical Research Council/Association of British Pharmaceutical Industries fund. Dr Turner receives research funding from Linde Research Evolve Advance Lead (REAL) fund, National Institute for Health Research, Wellcome Trust, and the Alpha-1 Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(4):1152-1162. doi:10.1378/chest.13-0161
Text Size: A A A
Published online

Background:  The new GOLD (Global Initiative for Chronic Obstructive Lung Disease) strategy recommends use of the COPD Assessment Test (CAT) or modified Medical Research Council (mMRC) scale to assess symptoms in COPD against “risk” as assessed by spirometry or exacerbation frequency. We aimed to determine the concordance between CAT and mMRC scale in assessing risk in patients with α1-antitrypsin deficiency (AATD) and the CAT threshold for risk assessment at which similar proportions of patients are assigned into the risk categories.

Methods:  Distribution of 309 patients (protease inhibitor Z phenotype) in four GOLD categories (A, B, C, and D) was compared. Using CAT for symptoms, we compared patient distribution using scores between 10 and 15 to ascertain the CAT threshold at which the distribution of patients in each group is proportional.

Results:  Using CAT 10 and spirometry for risk assessment, 6.1% of patients were in group A (low symptoms/low risk), 39.2% in B (high symptoms/low risk), 2.3% in C (low symptoms/high risk), and 52.4% in D (high symptoms/high risk). Using mMRC scale and spirometry for risk produced a significantly different distribution from that using CAT (P < .0001). Using CAT 13 as a symptom threshold and spirometry for risk resulted in a more proportional distribution of patients, which was similar using CAT and exacerbation history (P > .0001) and mMRC scale and spirometry and/or exacerbation history for risk (P > .0001).

Conclusions:  In patients with AATD, using either the mMRC scale 0 to 1 or CAT 10 scores to determine symptoms results in a significant difference in patient distribution. However, CAT 13 as the threshold for assessing symptoms results in a similar proportion of patients being categorized into the risk categories.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543