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      Variation in Assignment of the COPD Patients into a GOLD Group According to Symptoms Severity

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          The Global Organization of Lung Disease (GOLD) classifies patients with chronic obstructive pulmonary disease (COPD) taking into account the symptoms. The modified Medical Research Council’s dyspnea scale (mMRC) and the COPD assessment test (CAT) are used to assess these symptoms. In this study, we analyze the concordance of GOLD classification using mMRC and CAT.

          Patients and Methods

          This is an observational study of a cohort of 169 patients with COPD, who were classified following the GOLD 2017 recommendations, using both mMRC and CAT. A concordance analysis was applied, and a ROC curve was generated to identify the CAT score that best concorded with the mMRC scale.


          The concordance for the GOLD groups classified by CAT and mMRC was moderate ( kappa 0.492). For mMRC score of 1 and 2, a CAT score of ≥9 and ≥16 showed the maximum value of the Youden index, respectively. By reclassifying the patients with the new cut-off points obtained, the best concordance was obtained between the cut-off point for CAT of 16 and for mMRC of 2, followed by CAT of 9 and mMRC of 1.


          Because of the deficient concordance between CAT and mMRC, we propose the use of new cut-off points in future updates of the GOLD strategy.

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          Most cited references 17

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          Clinical Significance of Symptoms in Smokers with Preserved Pulmonary Function.

          Currently, the diagnosis of chronic obstructive pulmonary disease (COPD) requires a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.70 as assessed by spirometry after bronchodilator use. However, many smokers who do not meet this definition have respiratory symptoms.
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            John LIZARS. Centenary of a forgotten pioneer of the surgery of trigeminal neuralgia.

             S Behrman (1960)
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              The COPD assessment test: a systematic review.

              The COPD assessment test (CAT) is a self-administered questionnaire that measures health-related quality of life. We aimed to systematically evaluate the literature for reliability, validity, responsiveness and minimum clinically important difference (MCID) of the CAT. Multiple databases were searched for studies analysing the psychometric properties of the CAT in adults with chronic obstructive pulmonary disease. Two reviewers independently screened, selected and extracted data, and assessed methodological quality of relevant studies using the COSMIN checklist. From 792 records identified, 36 studies were included. The number of participants ranged from 45 to 6469, mean age from 56 to 73 years, and mean forced expiratory volume in 1 s from 39% to 98% predicted. Internal consistency (reliability) was 0.85-0.98, and test-retest reliability was 0.80-0.96. Convergent and longitudinal validity using Pearson's correlation coefficient were: SGRQ-C 0.69-0.82 and 0.63, CCQ 0.68-0.78 and 0.60, and mMRC 0.29-0.61 and 0.20, respectively. Scores differed with GOLD stages, exacerbation and mMRC grades. Mean scores decreased with pulmonary rehabilitation (2.2-3 units) and increased at exacerbation onset (4.7 units). Only one study with adequate methodology reported an MCID of 2 units and 3.3-3.8 units using the anchor-based approach and distribution-based approach, respectively. Most studies had fair methodological quality. We conclude that the studies support the reliability and validity of the CAT and that the tool is responsive to interventions, although the MCID remains debatable.

                Author and article information

                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of Chronic Obstructive Pulmonary Disease
                12 August 2020
                : 15
                : 1987-1995
                [1 ]Faculty of Medicine, Francisco de Vitoria University , Madrid 28223, Spain
                [2 ]Rey Juan Carlos University , Madrid 28922, Spain
                [3 ]Pulmonology Service, Gregorio Marañón University General Hospital , Madrid 28007, Spain
                [4 ]Pulmonology Service, El Escorial Hospital , Madrid 28200, Spain
                [5 ]Public Health and Maternal and Child Health Department, Faculty of Medicine, Complutense University of Madrid , Madrid 28040, Spain
                [6 ]Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University , Madrid 28922, Spain
                [7 ]Pulmonology Service, Lozano Blesa University Clinical Hospital , Zaragoza 50009, Spain
                Author notes
                Correspondence: Javier de Miguel-Díez Pulmonology Service, Gregorio Marañón, University General Hospital , Madrid28007, SpainTel +34 91 586 88 00 Email
                © 2020 Moya-Álvarez 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. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (

                Page count
                Figures: 5, Tables: 6, References: 26, Pages: 9
                Funded by: SEPAR (Sociedad Española de Neumología y Cirugía Torácica);
                Funded by: NEUMOMADRID (Sociedad Madrileña de Neumología y Cirugía de Tórax);
                This study is a part of the research funded by: a) SEPAR (Sociedad Española de Neumología y Cirugía Torácica): project no.733 of the 2018 edition; and b) NEUMOMADRID (Sociedad Madrileña de Neumología y Cirugía de Tórax): XVIII Awards Edition, 2018.
                Original Research


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