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Validation of the COPD severity score for use in primary care: the NEREA study

¹ Pneumology Dept, Clinic Institute of Thorax, Ciber de Enfermedades Respiratorias, Hospital Clinic, ² Primary Health Care Center "Jaume I", Catalan Society of Family Medicine, Rovira i Virgili University, Tarragona, ³ R&D&I Unit and ⁵ Project Management Dept, 3D Health Research, Barcelona, and ⁴ Clinical Development & Medical Advice, J. Uriach & Compañía, Palau Solità Plegamans, Spain.

CORRESPONDENCE: M. Miravitlles, Servei de Pneumologia, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain. Fax: 34 932275549. E-mail: marcm{at}clinic.ub.es

Keywords: Chronic obstructive pulmonary disease, outcome assessment, primary care, questionnaires

Received: June 9, 2008
Accepted October 31, 2008

Spirometry is underused for the assessment of severity of chronic obstructive pulmonary disease (COPD) in primary care (PC). Therefore, simple assessment tools are required in this setting. The aim of the present study was to validate the COPD severity score (COPDSS) for use in PC.

A multicentric study was carried out in stable COPD patients in PC. The concurrent validity of the COPDSS was evaluated by examining the association between COPDSS, COPD clinical indicators and the London Chest Activity of Daily Living (LCADL) scale, European quality of life (EuroQOL) questionnaires and Charlson comorbidity index.

A total of 837 patients with COPD were analysed (males 84.3%; mean±SD age 68±11 yrs; forced expiratory volume in one second 54.6±17.7% of the predicted value). A strong correlation was found between COPDSS and dyspnoea level and a moderate correlation between COPDSS and exacerbation number. The COPDSS discriminated between patients with varying degrees of dyspnoea (area under receiver operating characteristic (ROC) curve 0.837), and according to number of exacerbations in the last year (area under ROC curve 0.773). Higher COPDSS scores were significantly associated with lower EuroQOL scores, lower EuroQOL visual analogue scale scores and higher LCADL scores.

The present results indicate that the chronic obstructive pulmonary disease severity score is a useful and reliable tool for assessing the severity of chronic obstructive pulmonary disease in primary care.