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      Distinct symptom experiences in subgroups of patients with COPD

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          In addition to their respiratory symptoms, patients with COPD experience multiple, co-occurring symptoms.


          The aims of this study were to identify subgroups of COPD patients based on their distinct experiences with 14 symptoms and to determine how these subgroups differed in demographic and clinical characteristics and disease-specific quality of life.

          Patients and methods

          Patients with moderate, severe, and very severe COPD (n=267) completed a number of self-report questionnaires. Latent class analysis was used to identify subgroups of patients with distinct symptom experiences based on the occurrence of self-reported symptoms using the Memorial Symptom Assessment Scale.


          Based on the probability of occurrence of a number of physical and psychological symptoms, three subgroups of patients (ie, latent classes) were identified and named “high”, “intermediate”, and “low”. Across the three latent classes, the pairwise comparisons for the classification of airflow limitation in COPD were not significantly different, which suggests that measurements of respiratory function are not associated with COPD patients’ symptom burden and their specific needs for symptom management. While patients in both the “high” and “intermediate” classes had high occurrence rates for respiratory symptoms, patients in the “high” class had the highest occurrence rates for psychological symptoms. Compared with the “intermediate” class, patients in the “high” class were younger, more likely to be women, had significantly more acute exacerbations in the past year, and reported significantly worse disease-specific quality of life scores.


          These findings suggest that subgroups of COPD patients with distinct symptom experiences can be identified. Patients with a higher symptom burden warrant more detailed assessments and may have therapeutic needs that would not be identified using current classifications based only on respiratory function.

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          Most cited references 35

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          The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.

          To develop the Self-Administered Comorbidity Questionnaire (SCQ) and assess its psychometric properties, including the predictive validity of the instrument, as reflected by its association with health status and health care utilization after 1 year. A cross-sectional comparison of the SCQ with a standard, chart abstraction-based measure (Charlson Index) was conducted on 170 inpatients from medical and surgical care units. The association of the SCQ with the chart-based comorbidity instrument and health status (short form 36) was evaluated cross sectionally. The association between these measures and health status and resource utilization was assessed after 1 year. The Spearman correlation coefficient for the association between the SCQ and the Charlson Index was 0.32. After restricting each measure to include only comparable items, the correlation between measures was stronger (Spearman r = 0.55). The SCQ had modest associations with measures of resource utilization during the index admission, and with health status and resource utilization after 1 year. The SCQ has modest correlations with a widely used medical record-based comorbidity instrument, and with subsequent health status and utilization. This new measure represents an efficient method to assess comorbid conditions in clinical and health services research. It will be particularly useful in settings where medical records are unavailable.
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            Mplus user’s guide

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              Interpreting thresholds for a clinically significant change in health status in asthma and COPD.

              Health status (or Health-Related Quality of Life) measurement is an established method for assessing the overall efficacy of treatments for asthma and chronic obstructive pulmonary disease (COPD). Such measurements can indicate the potential clinical significance of a treatment's effect. This paper is concerned with methods of estimating the threshold of clinical significance for three widely used health status questionnaires for asthma and COPD: the Asthma Quality of Life Questionnaire, Chronic Respiratory Questionnaire and St George's Respiratory Questionnaire. It discusses the methodology used to obtain such estimates and shows that the estimates appear to be fairly reliable; ie. for a given questionnaire, similar estimates may be obtained in different studies. These empirically derived thresholds are all mean estimates with confidence intervals around them. The presence of these confidence intervals affects the way in which the thresholds may be used to draw inferences concerning the clinical relevance of clinical trial results. A new system of judging the magnitude of clinically significant results is proposed. Finally, an attempt is made to translate these thresholds into scenarios that illustrate what a clinically significant change with treatment may mean to an individual patient.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                02 August 2016
                : 11
                : 1801-1809
                [1 ]Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Ullevål
                [2 ]Institute of Clinical Medicine, Faculty of Medicine, University of Oslo
                [3 ]Lovisenberg Diaconal University College
                [4 ]Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
                [5 ]Department of Community Health Systems
                [6 ]Department of Physiological Nursing, University of California, San Francisco, CA, USA
                [7 ]Department of Circulation and Medical Imaging, St Olav’s University Hospital, Trondheim
                [8 ]Department of Health Studies, University of Stavanger, Stavanger
                [9 ]Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
                Author notes
                Correspondence: Are M Holm, Department of Respiratory Medicine, Oslo University Hospital, Rikshospitalet, Pb 4950 Nydalen, 0424 Oslo, Norway, Tel +47 9119 8865, Email a.m.holm@
                © 2016 Christensen et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Original Research

                Respiratory medicine

                symptom experience, latent class analysis, copd, quality of life


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