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Original Research: COPD |

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 COPDSymptoms Evaluation With GOLD and Mortality

Ciro Casanova, MD; Jose M. Marin, MD; Cristina Martinez-Gonzalez, MD; Pilar de Lucas-Ramos, MD; Isabel Mir-Viladrich, MD; Borja Cosio, MD; German Peces-Barba, MD; Ingrid Solanes-García, MD; Ramón Agüero, MD; Nuria Feu-Collado, MD; Miryam Calle-Rubio, MD; Inmaculada Alfageme, MD; Alfredo de Diego-Damia, MD; Rosa Irigaray, MD; Margarita Marín, MD; Eva Balcells, MD; Antonia Llunell, MD; Juan Bautista Galdiz, MD; Rafael Golpe, MD; Celia Lacarcel, MD; Carlos Cabrera, MD; Alicia Marin, MD; Joan B. Soriano, MD; Jose Luis Lopez-Campos, MD; Juan José Soler-Cataluña, MD; Juan P. de-Torres, MD; for the COPD History Assessment in Spain (CHAIN) Cohort
Author and Funding Information

From the Pulmonary Department (Dr Casanova), Hospital Universitario Nuestra Señora de Candelaria, Tenerife; Pulmonary Department (Dr J. M. Marin), Hospital Universitario Miguel Servet, Zaragoza; Pulmonary Department (Dr Martinez-Gonzalez), Hospital Universitario Central de Asturias, Oviedo; Pulmonary Department I (Dr de Lucas-Ramos), Hospital General Universitario Gregorio Marañón, Madrid; Pulmonary Department (Dr Mir-Viladrich), Hospital Son Llátzer, Mallorca; Pulmonary Department (Dr Cosio), Hospital Universitario Son Espases-IDISPA, Palma de Mallorca; CIBER de Enfermedades Respiratorias (CIBERES) (Drs Cosio, Peces-Barba, Balcells, and Lopez-Campos), Instituto de Salud Carlos III, Madrid; Pulmonary Department (Dr Peces-Barba), Hospital Universitario Fundación Jiménez Díaz, Madrid; Pulmonary Department (Dr Solanes-García), Hospital de la Santa Creu i Sant Pau, Barcelona; Pulmonary Department (Dr Agüero), Hospital Universitario Marqués de Valdecilla, Santander; Pulmonary Department (Dr Feu-Collado), Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Córdoba; Pulmonary Department (Dr Calle-Rubio), Hospital Universitario Clinico San Carlos, Madrid; Pulmonary Department (Dr Alfageme), Hospital Universitario de Valme, Sevilla; Pulmonary Department (Dr de Diego-Damia), Hospital Universitario y Politécnico de la Fe, Valencia; Pulmonary Department (Dr Irigaray), Hospital de Manacor, Mallorca; Pulmonary Department (Dr Marín), Hospital General de Castellon, Castellon; Pulmonary Department (Dr Balcells), Hospital del Mar, Barcelona; Pulmonary Department (Dr Llunell), Hospital de Tarrasa, Tarrasa; Pulmonary Department (Dr Galdiz), Hospital Universitario de Cruces, Bilbao; Pulmonary Department (Dr Golpe), Hospital General de Calde, Lugo; Pulmonary Department (Dr Lacarcel), Hospital Ciudad de Jaén, Jaén; Pulmonary Department (Dr Cabrera), Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria; Pulmonary Department (Dr A. Marin), Hospital Universitario Germans Trias y Pujol, Badalona, Barcelona; Instituto de Investigación Hospital Universitario de la Princesa (IISP) (Dr Soriano), Universidad Autónoma de Madrid, Cátedra UAM-Linde, Madrid; Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS) (Dr Lopez-Campos), Hospital Universitario Virgen del Rocío, Sevilla; Pulmonary Department (Dr Soler-Cataluña), Hospital Universitario Arnau de Vilanova, Valencia; and Pulmonary Department (Dr de-Torres), Clínica Universidad de Navarra, Pamplona, Spain.

CORRESPONDENCE TO: Ciro Casanova, MD, Universidad de La Laguna, Tenerife, Respiratory Research Unit, Pulmonary Department, Hospital Universitario Nuestra Señora de Candelaria, Carretera del Rosario no. 145, 38010-Santa Cruz de Tenerife, Spain; e-mail: casanovaciro@gmail.com


FUNDING/SUPPORT: Financial support was provided by AstraZeneca.

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


Chest. 2015;148(1):159-168. doi:10.1378/chest.14-2449
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OBJECTIVE:  The modified Medical Research Council (mMRC) dyspnea, the COPD Assessment Test (CAT), and the Clinical COPD Questionnaire (CCQ) have been interchangeably proposed by GOLD (Global Initiative for Chronic Obstructive Lung Disease) for assessing symptoms in patients with COPD. However, there are no data on the prognostic value of these tools in terms of mortality. We endeavored to evaluate the prognostic value of the CAT and CCQ scores and compare them with mMRC dyspnea.

METHODS:  We analyzed the ability of these tests to predict mortality in an observational cohort of 768 patients with COPD (82% men; FEV1, 60%) from the COPD History Assessment in Spain (CHAIN) study, a multicenter observational Spanish cohort, who were monitored annually for a mean follow-up time of 38 months.

RESULTS:  Subjects who died (n = 73; 9.5%) had higher CAT (14 vs 11, P = .022), CCQ (1.6 vs 1.3, P = .033), and mMRC dyspnea scores (2 vs 1, P < .001) than survivors. Receiver operating characteristic analysis showed that higher CAT, CCQ, and mMRC dyspnea scores were associated with higher mortality (area under the curve: 0.589, 0.588, and 0.649, respectively). CAT scores ≥ 17 and CCQ scores > 2.5 provided a similar sensitivity than mMRC dyspnea scores ≥ 2 to predict all-cause mortality.

CONCLUSIONS:  The CAT and the CCQ have similar ability for predicting all-cause mortality in patients with COPD, but were inferior to mMRC dyspnea scores. We suggest new thresholds for CAT and CCQ scores based on mortality risk that could be useful for the new GOLD grading classification.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov

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