1
|
Tsiligianni IG, Alma HJ, de Jong C, Jelusic D, Wittmann M, Schuler M, Schultz K, Kollen BJ, van der Molen T, Kocks JWH. Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George's Respiratory Questionnaire cutoff 25 (and 20) as reference. Int J Chron Obstruct Pulmon Dis 2016; 11:1045-52. [PMID: 27274226 PMCID: PMC4876797 DOI: 10.2147/copd.s99793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the GOLD (Global initiative for chronic Obstructive Lung Disease) strategy document, the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), or modified Medical Research Council (mMRC) scale are recommended for the assessment of symptoms using the cutoff points of CCQ ≥1, CAT ≥10, and mMRC scale ≥2 to indicate symptomatic patients. The current study investigates the criterion validity of the CCQ, CAT and mMRC scale based on a reference cutoff point of St George's Respiratory Questionnaire (SGRQ) ≥25, as suggested by GOLD, following sensitivity and specificity analysis. In addition, areas under the curve (AUCs) of the CCQ, CAT, and mMRC scale were compared using two SGRQ cutoff points (≥25 and ≥20). MATERIALS AND METHODS Two data sets were used: study A, 238 patients from a pulmonary rehabilitation program; and study B, 101 patients from primary care. Receiver-operating characteristic (ROC) curves were used to assess the correspondence between the recommended cutoff points of the questionnaires. RESULTS Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥25 were: study A, 0.99, 0.43, and 0.96 for CCQ ≥1, 0.92, 0.48, and 0.89 for CAT ≥10, and 0.68, 0.91, and 0.91 for mMRC ≥2; study B, 0.87, 0.77, and 0.9 for CCQ ≥1, 0.76, 0.73, and 0.82 for CAT ≥10, and 0.21, 1, and 0.81 for mMRC ≥2. Sensitivity, specificity, and AUC scores for cutoff point SGRQ ≥20 were: study A, 0.99, 0.73, and 0.99 for CCQ ≥1, 0.91, 0.73, and 0.94 for CAT ≥10, and 0.66, 0.95, and 0.94 for mMRC ≥2; study B, 0.8, 0.89, and 0.89 for CCQ ≥1, 0.69, 0.78, and 0.8 for CAT ≥10, and 0.18, 1, and 0.81 for mMRC ≥2. CONCLUSION Based on data from these two different samples, this study showed that the suggested cutoff point for the SGRQ (≥25) did not seem to correspond well with the established cutoff points of the CCQ or CAT scales, resulting in low specificity levels. The correspondence with the mMRC scale seemed satisfactory, though not optimal. The SGRQ threshold of ≥20 corresponded slightly better than SGRQ ≥25, recently suggested by GOLD 2015, with the established cutoff points for the CCQ, CAT, and mMRC scale.
Collapse
Affiliation(s)
- Ioanna G Tsiligianni
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Harma J Alma
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Corina de Jong
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Danijel Jelusic
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Wittmann
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Michael Schuler
- Department of Medical Psychology, Psychotherapy and Rehabilitation Sciences, University of Würzburg, Würzburg, Germany
| | - Konrad Schultz
- Klinik Bad Reichenhall, Center for Rehabilitation, Pulmonology and Orthopedics, Bad Reichenhall, Germany
| | - Boudewijn J Kollen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Thys van der Molen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| | - Janwillem WH Kocks
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
- GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Germany
| |
Collapse
|
2
|
Kerstjens HAM, Deslée G, Dahl R, Donohue JF, Young D, Lawrence D, Kornmann O. The impact of treatment with indacaterol in patients with COPD: A post-hoc analysis according to GOLD 2011 categories A to D. Pulm Pharmacol Ther 2015; 32:101-8. [PMID: 25743376 DOI: 10.1016/j.pupt.2015.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 02/18/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Indacaterol is an inhaled, once-daily, ultra-long-acting β2-agonist for the treatment of chronic obstructive pulmonary disease (COPD). We report on the effectiveness of indacaterol and other bronchodilators compared with placebo in patients across the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 categories A to D. METHODS A post-hoc, subgroup pooled analysis of 6-month efficacy data from three randomized, placebo-controlled, parallel-group studies involving 3862 patients was performed across GOLD 2011 categories A to D, according to baseline forced expiratory volume in 1 s (FEV1) % predicted, modified Medical Research Council (mMRC) dyspnea scale, and exacerbation history in the 12 months prior to entry. Efficacy of once-daily indacaterol 150 and 300 μg, open-label tiotropium 18 μg, twice-daily salmeterol 50 μg, and formoterol 12 μg was compared with placebo. End points analysed were trough FEV1, transition dyspnea index (TDI), and St George's Respiratory Questionnaire (SGRQ) total score, all at Week 26, and mean rescue medication use over 26 weeks. RESULTS Indacaterol 150 and 300 μg significantly improved FEV1, compared with placebo across all GOLD groups. Indacaterol 150 and 300 μg also significantly improved TDI, SGRQ total score, and mean rescue medication use compared with placebo across most GOLD subgroups. CONCLUSIONS Treatment selection according to patient's symptoms as well as lung function is an important consideration in maintenance treatment of COPD. Indacaterol 150 and 300 μg effectively improved lung function and symptoms in patients across all GOLD 2011 categories.
Collapse
Affiliation(s)
- Huib A M Kerstjens
- University of Groningen, University Medical Center, and Groningen Research Institute for Asthma and COPD GRIAC, Groningen, the Netherlands.
| | - Gaëtan Deslée
- Service de Pneumologie, Hôpital Maison Blanche, INSERM U903, CHU de Reims, France.
| | - Ronald Dahl
- Allergy Centre, Odense University Hospital, Odense, Denmark.
| | - James F Donohue
- Department of Medicine, University of North Carolina, NC, USA.
| | - David Young
- Novartis Horsham Research Centre, Horsham, West Sussex, UK.
| | - David Lawrence
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
| | - Oliver Kornmann
- IKF Pneumologie Frankfurt, Clinical Research Centre Respiratory Diseases, Frankfurt, Germany.
| |
Collapse
|
3
|
Kardos P, Vogelmeier C, Buhl R, Criée CP, Worth H. The Prospective Non-Interventional DACCORD Study in the National COPD Registry in Germany: design and methods. BMC Pulm Med 2015; 15:2. [PMID: 25578330 PMCID: PMC4417326 DOI: 10.1186/1471-2466-15-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2014] [Accepted: 01/06/2015] [Indexed: 11/24/2022] Open
Abstract
Background A variety of large randomized controlled trials (RCT’s) evaluating pharmacotherapy in chronic obstructive pulmonary disease (COPD) patients does exist. One of the drugs that has been tested is the new long-acting anticholinergic glycopyrronium bromide. Methods As the generalizability of results from RCT’s is questionable we designed a longitudinal, prospective non-interventional study (DACCORD) of two years duration plus two years extension with at least 6000 participants in approximately 500 primary and secondary care practices in Germany (within the new established COPD National Prospective Registry), to assess patient reported outcomes (PRO’s), lung function, adherence and drug safety. To circumvent the hurdle of inappropriate COPD diagnosis in a non-interventional trial, patients have to fulfill the inclusion criteria of the COPD disease management program (DMP) of the German statutory health insurances. Patient management should follow the German national COPD guidelines, which are based on Global Initiative for Chronic Obstructive Lung Disease 2007 (GOLD) report. Labels of prescribed drugs should also be taken into account. Patients received treatment as part of their standard care: at the discretion of the investigator patients were included in one of two arms. A: standard care with glycopyrronium containing regimen, and arm B: standard care without glycopyrronium. Discussion For 2016 we expect important results regarding longitudinal development of PRO’s including exacerbations, lung function, adherence and side effects. We also investigate applicability of the new GOLD staging system in usual care. Data on diagnostic and treatment modalities in current German primary and secondary care, as well as pharmaco-economic data will be generated. Trial registration 1. German Register for non-interventional studies: http://www.vfa.de/de/arzneimittel-forschung/datenbanken-zu-arzneimitteln/nisdb. 2. EMA EnCePP http://www.encepp.eu/.
Collapse
Affiliation(s)
- Peter Kardos
- Group Practice and Centre for Allergy, Respiratory and Sleep Medicine, Red Cross Maingau Hospital, Scheffelstrasse 33, 60318, Frankfurt am Main, Germany.
| | - Claus Vogelmeier
- Department of Respiratory Diseases, University of Marburg, 35043, Marburg, Germany.
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, 55131, Mainz, Germany.
| | - Carl-Peter Criée
- Department of Sleep and Respiratory Medicine, Evangelical Hospital Goettingen-Weende, 37120, Bovenden, Germany.
| | - Heinrich Worth
- Department of Pulmonology and Cardiology, Hospital Fuerth, University Erlangen-Nuernberg, 90766, Fuerth, Germany.
| |
Collapse
|
4
|
Boland MRS, Tsiachristas A, Kruis AL, Chavannes NH, Rutten-van Mölken MPMH. Are GOLD ABCD groups better associated with health status and costs than GOLD 1234 grades? A cross-sectional study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:30-7. [PMID: 24449017 PMCID: PMC6442289 DOI: 10.4104/pcrj.2014.00002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Aims: To investigate the association of the GOLD ABCD groups classification with costs and health-related quality of life (HR-QoL) and to compare this with the GOLD 1234 grades classification that was primarily based on lung function only. Methods: In a cross-sectional study, we selected patients diagnosed with chronic obstructive pulmonary disease (COPD) from electronic medical records of general practices. Multi-level analysis was used with costs (medication, primary care, healthcare, societal), disease-specific and generic HR-QoL as independent variables. Either the new or the old GOLD stages were included in the analysis together with several covariates (age, gender, living situation, co-morbidity, self-efficacy, smoking, education, employment). Results: 611 patients from 28 general practices were categorised as GOLD-A (n=333), GOLD-B (n=110), GOLD-C (n=80) and GOLD-D (n=88). Patients in the GOLD-B and GOLD-D groups had the highest prevalence of co-morbidities and the lowest level of physical activity, self-efficacy, and employment. The models with GOLD ABCD groups were more strongly related to and explained more variance in costs and in disease-specific and generic HR-QoL than the models with GOLD 1234 grades. The mean Clinical COPD Questionnaire score worsened significantly, with scores 1.04 (GOLD-B), 0.4 (GOLD-C) and 1.21 (GOLD-D) worse than for patients in GOLD-A. Healthcare costs per patient were significantly higher in GOLD-B (72%), GOLD-C (74%) and GOLD-D (131%) patients than in GOLD-A patients. Conclusions: The GOLD ABCD groups classification is more closely associated with costs and HR-QoL than the GOLD 1234 grades classification. Furthermore, patients with GOLD-C had a better HR-QoL than those with GOLD-B but the costs of the two groups did not differ.
Collapse
Affiliation(s)
- Melinde R S Boland
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands • Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | | | | | | |
Collapse
|