title: Comparison of disease-severity measures within severe and very severe COPD patients: results from a nationally representative chart review and patient survey.
abstract: OBJECTIVE
  This study aimed to compare spirometry- and risk + symptom-based classification systems to physician-based severity assessment and find which system is most predictive of patient-reported health status, as measured by the St George's Respiratory Questionnaire for COPD (chronic obstructive pulmonary disease; SGRQ-C).
  
  
  METHODS
  In this chart review/patient survey, 99 physicians recruited patients with physician-assessed severe or very severe COPD who had recently experienced a moderate or severe exacerbation. A cross-tabulation was undertaken comparing physician report, spirometry (mild/moderate, forced expiratory volume in 1 second [FEV1] ≥50%; severe, 30% ≤ FEV1 <50%; very severe, FEV1 <30% predicted), and risk + symptom-based (A, low risk/fewer symptoms; B, low risk/more symptoms; C, high risk/fewer symptoms; D, high risk/more symptoms) severity systems. Analysis of covariance models were run for SGRQ-C, varying COPD-severity systems.
  
  
  RESULTS
  Of 244 patients, 58.6% were severe and 34.8% very severe by physician report, 70% had FEV1 ≤50% at their most recent visit, and 86% fell into quadrant D. Spirometry and physician report had 57.4% agreement, with physicians often indicating higher severity. Physician report and risk + symptom agreement was high (81.2% severe/very severe and D). Physician-reported severity, risk + symptoms, exacerbations in the previous year, and symptoms were significant SGRQ-C predictors, while spirometry was not.
  
  
  CONCLUSIONS
  For recently exacerbating severe or very severe COPD patients, risk + symptoms more closely aligned with physician-reported severity and SGRQ-C versus spirometry.
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Caitlyn T
authors.initials: CT
authors.lastname: Solem
authors.affiliation: Forest Research Institute, Jersey City, NJ, USA.
authors.forename: Shawn X
authors.initials: SX
authors.lastname: Sun
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Sizhu
authors.initials: S
authors.lastname: Liu
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Macahilig
authors.affiliation: Medical Data Analytics, Parsippany, NJ, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Katyal
authors.affiliation: Pharmerit International, Bethesda, MD, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Gao
authors.affiliation: Pulmonary Critical Care, Washington Hospital Center and Georgetown University, Washington, DC, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Shorr
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013147:Spirometry; D011795:Surveys and Questionnaires
keywords: COPD; disease-severity measures; pharmacoepidemiology