• Sarah Wilke, Dionne E Smid, Martijn A Spruit, JanssenDaisy J ADJADepartment of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.Centre of Expertise for Palliative Care, Maastricht University Medical Centre, the Netherlands., MurisJean W MJWMCaphri School of Public Health and Primary Care, Department of Family Medicine, Maastricht University, the Netherlands., Thys van der Molen, Marjan van den Akker, Paul W Jones, WoutersEmiel F MEFMDepartment of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands.Department of Respiratory Medicine, Maastricht University Medical Centre, the Netherlands., and FranssenFrits M EFMEDepartment of Research and Education, CIRO+, Centre of Expertise for Chronic Organ Failure, Horn, the Netherlands..
• Joint first author.
• Chronic Obstr Pulm Dis (Miami). 2014 Sep 25; 1 (2): 212-220.

AbstractBackground: The 2014 updated Global initiative for chronic Obstructive Lung Disease (GOLD) strategy added the St. George's Respiratory Questionnaire (SGRQ) as the fourth possible symptoms measure. The impact of the suggested tools for symptoms of COPD and the different definitions of future risk on the frequency distribution and clinical characteristics of the GOLD groups remain unknown. Methods: Demographic and clinical characteristics were assessed in 542 patients with COPD (57.7% male, age 64.6 [9.0] years, FEV1 54.7 [22.3]% predicted). Health status was assessed by the COPD-specific SGRQ and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale, anxiety (HADS-A) and depression (HADS-D) subscale. Cohen's Kappa was used to assess agreement between groups. Results: Level of agreement in frequency distribution using the modified Medical Research Council dyspnea (mMRC) scale ≥2, COPD Assessment Test (CAT) ≥10, Clinical COPD Questionnaire (CCQ) ≥1 and SGRQ ≥25 was moderate to very good. Best agreement was reached between CCQ and SGRQ (К = 0.838 or 0.851, p<0.001). Patients classified in mMRC GOLD A reported higher SGRQ scores, higher HADS-A and HADS-D scores compared to patients classified in CAT GOLD A or SGRQ GOLD A. Outcomes were comparable between the risk assessment groups. Conclusions: Choice of the symptom measure impacts GOLD groups more than choice of the exacerbation risk assessment. Health care professionals should be aware that patients are heterogeneous in terms of health status and symptoms of anxiety and depression based on the symptom measure used.

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