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

Introduction: 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. Results: 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. Conclusion: 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.

Differences in the Outcome of Patients with COPD according to Body Mass Index.

BACKGROUND: In chronic obstructive pulmonary disease (COPD), the "obesity paradox" is a phenomenon without a clear cause. The objective is to analyze the complications of COPD patients according to their body mass index (BMI). METHODS: An observational study with a six-year prospective follow-up of 273 COPD patients who attended a spirometry test in 2011. Survival and acute events were analyzed according to the BMI quartiles. RESULTS: A total of 273 patients were included. BMI quartiles were ≤24.23; 24.24-27.69; 27.70-31.25; ≥31.26. During the follow-up, 93 patients died. No differences were found in exacerbations, pneumonia, emergency visits, hospital admissions or income in a critical unit . Survival was lower in the quartile 1 of BMI with respect to each of the 2-4 quartiles (p-value 0.019, 0.013, and 0.004, respectively). Advanced age (hazard ratio, HR 1.06; 95% confidence interval, CI 1.03-1.09), low pulmonary function (HR 0.93; 95% CI 0.86-0.99), exacerbator with chronic bronchitis phenotype (HR 1.76; 95% CI 1.01-3.06), high Charlson (HR 1.32, 95% CI 1.18-1.49), and the quartile 1 of BMI (HR 1.99, 95% CI 1.08-3.69) were identified as risk factors independently associated with mortality. CONCLUSIONS: In COPD, low BMI conditions a lower survival, although not for having more acute events.

Tabaquismo y aspergilosis broncopulmonar alérgica: una mala combinación / Smoking habit and allergic bronchopulmonary aspergilosis: a bad combination

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