title: COPD as a multicomponent disease: inventory of dyspnoea, underweight, obesity and fat free mass depletion in primary care.
abstract: OBJECTIVE
  To describe the distribution of COPD disease severity in primary care based on airway obstruction, and to assess the extent to which dyspnoea scores, body mass index (BMI) and fat free mass (FFM) index contribute to the distribution of COPD severity in primary care.
  
  
  METHODS
  Cross sectional population-based study.
  
  
  METHODS
  317 patients with COPD were recruited from an outpatient disease management programme. Prevalence of moderate to severe dyspnoea, underweight, obesity and FFM depletion by GOLD stage were measured.
  
  
  RESULTS
  According to GOLD guidelines, 29% of patients had mild COPD, 48% moderate, 17% severe and 5% very severe. A substantial number of patients classified as GOLD stage 2 reported severe dyspnoea (28.1%) and/or suffered from FFM depletion (16.3%). Prevalence of low body weight strongly increased in GOLD stage 4. Prevalence of obesity is highest in GOLD stages 1 and 2.
  
  
  CONCLUSIONS
  The use of a multidimensional grading system, taking into account dyspnoea as well as the nutritional status of COPD patients, is likely to influence the distribution of disease severity in a primary care population. This might have implications for prevention, non-medical treatment, and estimates of health care utilisation in primary care.
authors.affiliation: Department of Health Care Studies, Faculty of Health Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. L.Steuten@zw.unimaas.nl
authors.forename: Lotte M G
authors.initials: LM
authors.lastname: Steuten
authors.forename: Eva C
authors.initials: EC
authors.lastname: Creutzberg
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.forename: Emiel F
authors.initials: EF
authors.lastname: Wouters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009752:Nutritional Status; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D012720:Severity of Illness Index; D012737:Sex Factors; D013851:Thinness / Q000453:epidemiology / Q000503:physiopathology*