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Little agreement in GOLD category using CAT and mMRC in 450 primary care COPD patients in New Zealand.

Holt S, Sheahan D, Helm C, Tofield C, Corin A, Kocks JW - NPJ Prim Care Respir Med (2014)

View Article: PubMed Central - PubMed

Affiliation: School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.

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The updated 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines introduced a new method to categorise chronic obstructive pulmonary disease (COPD) patients according to risk and symptom level, whereas previously categorisation was based solely on lung function impairment... We performed an audit of COPD patients in primary care to assess whether there were significant differences in GOLD category depending on whether the mMRC or the CAT were used, and also to determine the appropriateness of the medications that these patients were prescribed, according to GOLD recommendations... Four hundred and fifty patients were assessed in three primary care practices in New Zealand, and data were collected on patient demographics, FEV1, exacerbation history, CAT and mMRC scores, and prescribed medication... The prescribed medication level was rated as ‘undertreated’, ‘well treated’, ‘over treated’ or ‘other regime’... To establish each patient’s treatment level, their current medication use was compared with each GOLD treatment recommendation (first and second choice for GOLD stage A, B, C and D, thus resulting in eight ‘yes’ or ‘no’ according to, e.g., ‘second choice treatment for stage B’). ‘Well treated’ patients received pharmacotherapy that is listed for GOLD’s recommendation for first or second choice therapy for their category... In contrast, 68% of CAT-classified GOLD C patients received inhaled corticosteroids, which is not recommended for GOLD C patients... On average, patients in GOLD D used 2.7 (s.d. 1.2) different inhalers compared with 1.5 (s.d. 1.3) in GOLD A... The agreement in treatment level between patients categorised using mMRC or CAT was 0.94... This results in more patients having long-acting bronchodilators recommended for their treatment, and in this audit, it meant that the use of CAT meant that more patients were classified as undertreated in group B... The risk versus benefit of earlier treatment with long-acting bronchodilators is currently uncertain... However, data from primary care suggest that many people change categories over time, which could lead to step down of treatments... More studies are required to assess the effects of stepping down on outcomes... However, based on feasibility and applicability for primary care, the International Primary Care Respiratory Group has previously recommended the use of the CCQ or CAT... In summary, this audit found that there was a marked difference in GOLD category depending on the method of symptom assessment and that many patients are undertreated or prescribed a treatment regime not consistent with the GOLD guideline.

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Global Initiative for Chronic Obstructive Lung Disease (GOLD) category by treatment level by (a) modified Medical Research Council Dyspnoea Scale and (b) COPD Assessment Test (CAT).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
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fig1: Global Initiative for Chronic Obstructive Lung Disease (GOLD) category by treatment level by (a) modified Medical Research Council Dyspnoea Scale and (b) COPD Assessment Test (CAT).

Mentions: A graphical summary of the findings is shown in Figure 1.


Little agreement in GOLD category using CAT and mMRC in 450 primary care COPD patients in New Zealand.

Holt S, Sheahan D, Helm C, Tofield C, Corin A, Kocks JW - NPJ Prim Care Respir Med (2014)

Global Initiative for Chronic Obstructive Lung Disease (GOLD) category by treatment level by (a) modified Medical Research Council Dyspnoea Scale and (b) COPD Assessment Test (CAT).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373384&req=5

fig1: Global Initiative for Chronic Obstructive Lung Disease (GOLD) category by treatment level by (a) modified Medical Research Council Dyspnoea Scale and (b) COPD Assessment Test (CAT).
Mentions: A graphical summary of the findings is shown in Figure 1.

View Article: PubMed Central - PubMed

Affiliation: School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

The updated 2011 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines introduced a new method to categorise chronic obstructive pulmonary disease (COPD) patients according to risk and symptom level, whereas previously categorisation was based solely on lung function impairment... We performed an audit of COPD patients in primary care to assess whether there were significant differences in GOLD category depending on whether the mMRC or the CAT were used, and also to determine the appropriateness of the medications that these patients were prescribed, according to GOLD recommendations... Four hundred and fifty patients were assessed in three primary care practices in New Zealand, and data were collected on patient demographics, FEV1, exacerbation history, CAT and mMRC scores, and prescribed medication... The prescribed medication level was rated as ‘undertreated’, ‘well treated’, ‘over treated’ or ‘other regime’... To establish each patient’s treatment level, their current medication use was compared with each GOLD treatment recommendation (first and second choice for GOLD stage A, B, C and D, thus resulting in eight ‘yes’ or ‘no’ according to, e.g., ‘second choice treatment for stage B’). ‘Well treated’ patients received pharmacotherapy that is listed for GOLD’s recommendation for first or second choice therapy for their category... In contrast, 68% of CAT-classified GOLD C patients received inhaled corticosteroids, which is not recommended for GOLD C patients... On average, patients in GOLD D used 2.7 (s.d. 1.2) different inhalers compared with 1.5 (s.d. 1.3) in GOLD A... The agreement in treatment level between patients categorised using mMRC or CAT was 0.94... This results in more patients having long-acting bronchodilators recommended for their treatment, and in this audit, it meant that the use of CAT meant that more patients were classified as undertreated in group B... The risk versus benefit of earlier treatment with long-acting bronchodilators is currently uncertain... However, data from primary care suggest that many people change categories over time, which could lead to step down of treatments... More studies are required to assess the effects of stepping down on outcomes... However, based on feasibility and applicability for primary care, the International Primary Care Respiratory Group has previously recommended the use of the CCQ or CAT... In summary, this audit found that there was a marked difference in GOLD category depending on the method of symptom assessment and that many patients are undertreated or prescribed a treatment regime not consistent with the GOLD guideline.

Show MeSH
Related in: MedlinePlus