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array:20 [ "pii" => "X087321591585610X" "issn" => "08732159" "doi" => "10.1016/j.rppnen.2014.02.004" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:11-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9616 "formatos" => array:3 [ "EPUB" => 270 "HTML" => 8077 "PDF" => 1269 ] ] "itemSiguiente" => array:16 [ "pii" => "X0873215915856118" "issn" => "08732159" "doi" => "10.1016/j.rppnen.2014.03.017" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:16-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5635 "formatos" => array:3 [ "EPUB" => 245 "HTML" => 4237 "PDF" => 1153 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Long-term ventilation in children: Ten years later" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "16" "paginaFinal" => "21" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385611fig1.jpg" "Alto" => 843 "Ancho" => 1586 "Tamanyo" => 81996 ] ] "descripcion" => array:1 [ "en" => "Number of LTMV-10 children initiated on respiratory support per year." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Cancelinha, N. Madureira, P. Mação, P. Pleno, T. Silva, M.H. Estêvão, M. Félix" "autores" => array:7 [ 0 => array:2 [ "Iniciales" => "C." "apellidos" => "Cancelinha" ] 1 => array:2 [ "Iniciales" => "N." "apellidos" => "Madureira" ] 2 => array:2 [ "Iniciales" => "P." "apellidos" => "Mação" ] 3 => array:2 [ "Iniciales" => "P." "apellidos" => "Pleno" ] 4 => array:2 [ "Iniciales" => "T." "apellidos" => "Silva" ] 5 => array:2 [ "Iniciales" => "M.H." "apellidos" => "Estêvão" ] 6 => array:2 [ "Iniciales" => "M." "apellidos" => "Félix" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915856118?idApp=UINPBA00004E" "url" => "/08732159/0000002100000001/v0_201604141151/X0873215915856118/v0_201604141151/en/main.assets" ] "itemAnterior" => array:16 [ "pii" => "X0873215915856095" "issn" => "08732159" "doi" => "10.1016/j.rppnen.2014.06.009" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Rev Port Pneumol. 2015;21:5-10" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6466 "formatos" => array:3 [ "EPUB" => 247 "HTML" => 5126 "PDF" => 1093 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Bronchiectasis: A retrospective study of clinical and aetiological investigation in a general respiratory department" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "5" "paginaFinal" => "10" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385609fig1.jpg" "Alto" => 1088 "Ancho" => 1526 "Tamanyo" => 211021 ] ] "descripcion" => array:1 [ "en" => "Aetiological investigation. AAT, ¿1-antitrypsin." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Amorim, J. Bento, A.P. Vaz, I. Gomes, J. de Gracia, V. Hespanhol, A. Marques" "autores" => array:7 [ 0 => array:2 [ "Iniciales" => "A." "apellidos" => "Amorim" ] 1 => array:2 [ "Iniciales" => "J." "apellidos" => "Bento" ] 2 => array:2 [ "Iniciales" => "A.P." "apellidos" => "Vaz" ] 3 => array:2 [ "Iniciales" => "I." "apellidos" => "Gomes" ] 4 => array:2 [ "Iniciales" => "J." "apellidos" => "de Gracia" ] 5 => array:2 [ "Iniciales" => "V." "apellidos" => "Hespanhol" ] 6 => array:2 [ "Iniciales" => "A." "apellidos" => "Marques" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0873215915856095?idApp=UINPBA00004E" "url" => "/08732159/0000002100000001/v0_201604141151/X0873215915856095/v0_201604141151/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "titulo" => "The overall impact of COPD (CAT) and BODE index on COPD male patients: correlation?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "11" "paginaFinal" => "15" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Ladeira, T. Gomes, A. Castro, C. Ribeiro, M. Guimarães, N. Taveira" "autores" => array:6 [ 0 => array:4 [ "Iniciales" => "I." "apellidos" => "Ladeira" "email" => array:1 [ 0 => "ines.ladeira@chvng.min-saude.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "Iniciales" => "T." "apellidos" => "Gomes" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "A." "apellidos" => "Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 3 => array:3 [ "Iniciales" => "C." "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 4 => array:3 [ "Iniciales" => "M." "apellidos" => "Guimarães" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] ] ] 5 => array:3 [ "Iniciales" => "N." "apellidos" => "Taveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Resident in the Pulmonology Department of Centro Hospitalar Vila Nova de Gaia/Espinho, EPE, Portugal" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Resident in the Pulmonology Department of Centro Hospitalar Trás-os-Montes e Alto Douro, EPE, Portugal" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 2 => array:3 [ "entidad" => "Pulmonology Assistant in Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 3 => array:3 [ "entidad" => "Pulmonology Graduate Assistant in Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Portugal" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "<span class="elsevierStyleSup">*</span>" "correspondencia" => "Corresponding author. ines.ladeira@chvng.min-saude.pt" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385610fig1.jpg" "Alto" => 1308 "Ancho" => 1618 "Tamanyo" => 128978 ] ] "descripcion" => array:1 [ "en" => "Correlation between CAT score and BODE index score ( <span class="elsevierStyleItalic">R</span> 0.475, <span class="elsevierStyleItalic">p</span> 0.01)." ] ] ] "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Background</span><p class="elsevierStylePara">Chronic Obstructive Pulmonary Disease (COPD) is a common disease<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> (in Lisbon BOLD survey the estimated prevalence of COPD was 14.2%<a href="#bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a>) and the World Health Organization (WHO) estimates that it will be the fifth leading cause of disability (DALYs) and the fourth leading cause of death by the end of 2030.<a href="#bib1" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a></p><p class="elsevierStylePara">COPD patients often develop symptoms such as dyspnea, cough, chest tightness, exercise intolerance, sleep and mental disorders and social activity restriction, but COPD management and treatment have been largely based on spirometric assessment.<a href="#bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> Recently, GOLD guidelines proposed dyspnea measurement, health status/quality of life impairment, and number of exacerbations as key elements (in addition to spirometry) with which to manage and treat COPD,<a href="#bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> allowing health status and quality of life impairment to become part of overall COPD patients’ management and a major concern for physicians. Several health status questionnaires and/or quality of life tools, such as St. George's Respiratory Questionnaire (SGRQ),<a href="#bib5" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> Chronic Respiratory Questionnaire (CRQ),<a href="#bib6" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> Clinical COPD Questionnaire (CCQ),<a href="#bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> and COPD Assessment Test (CAT),<a href="#bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> have been developed due to this growing awareness of the importance of health status, in an attempt to find a reliable tool to use in clinical practice.<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> CAT is the most recently developed questionnaire for COPD (2009); it is simple, validated, and self-completed and should be given to all COPD patients, irrespective of disease severity. Although no study has been carried out as to how applicable this is to the Portuguese population, CAT has been validated for use in the Portuguese language and its applicability has been tested in several countries, including Spain<a href="#bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> and Brazil,<a href="#bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a> where it was considered a reliable instrument for evaluating patients with COPD. A recent study performed in 2011<a href="#bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a> proved that there was substantial agreement between CAT and SGRQ since CAT correlates very well with the SGRQ-C in stable COPD patients and during exacerbations.</p><p class="elsevierStylePara">The BODE index (body mass index, airflow obstruction, dyspnea, and exercise capacity) is a multidimensional grading system for COPD that includes symptoms assessment, nutritional state, exercise capacity and spirometric measure of airflow (FEV1 post-bronchodilator).<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> BODE reflects the progressive modification in the disease<a href="#bib14" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a> and it is useful for predicting hospitalization and the risk of death among patients with COPD,<a href="#bib15" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a> in the follow-up of lung functional change during pulmonary rehabilitation,<a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a> in predicting patient's survival after receiving lung volume reduction surgery<a href="#bib17" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a> and the worsening of health-related quality of life in COPD patients as measured by SGRQ<a href="#bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">, </span><a href="#bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">19</span></a><span class="elsevierStyleSup">, </span><a href="#bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">20</span></a> and the total Clinical COPD Questionnaire CCQ score (specially the functional status) which corroborates the link between BODE index and quality of life.<a href="#bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">21</span></a></p><p class="elsevierStylePara">Since CAT is a recently developed questionnaire, little is known about its correlation with BODE index in terms of measurement of quality of life. This study aimed to understand if there is a relationship between the CAT questionnaire and the BODE index in order to enhance the understanding of COPD in its global disease spectrum and consequences. Measuring COPD using CAT (“COPD Assessment Test”) may complement the BODE index as an indicator of morbidity and mortality.</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Materials and methods</span><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Subjects</span><p class="elsevierStylePara">This was a retrospective study using existing data of stable COPD patients, with optimized therapy (correct inhalation techniques after repeated teaching) in a Respiratory Rehabilitation program at the Pulmonology Department in Centro Hospitalar de Vila Nova de Gaia, Portugal, between January 2010 and October 2011. Fifty patients had been included after excluding those with concomitant asthma or any respiratory disease other than COPD. The study was approved by the Ethics Committee of the hospital.</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Data collection</span><p class="elsevierStylePara">Demographic information and medical records were reviewed (data collection was approved by the head of department and patient confidentiality was maintained). Baseline spirometry and carbon monoxide diffusion (DLCO) were performed before the beginning of the rehabilitation program respecting the ATS/ERS recommendations<a href="#bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">22</span></a> and using a standard Pulmonary Function Tests (PFT) unit. Blood gases were determined in arterialized samples. COPD diagnosis was based on examination by a chest physician including spirometry test after bronchodilator use with FEV1/FVC ratio lower than 0.70, and GOLD guidelines reviewed in 2010<a href="#bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> were used to classify disease severity since the latest GOLD guidelines<a href="#bib3" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a> were not available at the time this study was performed.</p><p class="elsevierStylePara">Body mass index (BMI), the modified Medical Research Council dyspnoea scale (MMRC),<a href="#bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">23</span></a> the 6-min walking test (6MWT) and pulse oxymetry before and after the 6MWT were assessed on the first visit. BODE index was calculated for classification of COPD using body mass index (BMI), post-bronchodilator FEV1 (% predicted), grade of dyspnoea (measured by the modified Medical Research Council dyspnoea scale - mMRC) and the 6MWT distance,<a href="#bib13" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> and patients were classified into severity stages: BODE 1 (score 0–2), BODE 2 (score 3–4), BODE 3 (score 5–6) and BODE 4 (score 7–10).<a href="#bib16" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a></p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Health status questionnaires</span><p class="elsevierStylePara">The COPD Assessment Test (CAT)<a href="#bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a> was applied to all subjects during the first and last visit to the rehabilitation training program. CAT has 8 items and raises questions about symptoms, energy, sleep and activity. CAT was classified into 4 classes: slight impact (score 0–10); medium impact (score 11–20), high impact (score 21–30) and very high impact (score > 30).</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Statistical analysis</span><p class="elsevierStylePara">The statistical analysis was performed using SPSS for Windows version 19 (SPSS Inc., USA). Continuous variables are presented as mean ± standard deviation (SD) and categorical variables as absolute number and/or percentage. Spearman's rank correlation test was performed to measure how closely the COPD assessed by CAT questionnaire agreed with the one assessed by the BODE index. <span class="elsevierStyleItalic">T</span>-test was used to compare means between CAT impact groups of patients (age and BMI). A 2-sided value of <span class="elsevierStyleItalic">p</span> < 0.05 was considered as statistically significant.</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">A total of 50 patients were included (the baseline characteristics of these patients are shown in <a href="#t0005" class="elsevierStyleCrossRefs">Table 1</a>): 48 males (96%) and 2 females (4%), with a mean age of 62.5±9.5 years. The average BMI was 25.8 kg/m<span class="elsevierStyleSup">2</span> (±4.8 kg/m<span class="elsevierStyleSup">2</span>). Considering pulmonary function, FEV1% predicted was 57.1 ± 19.6%, FEV1/FVC 53.2 ± 0.1%, DLCO 59.8 ± 19.9% and in the 6-min walk test, 8 of the 50 patients had significant desaturation (>4%) with a mean distance of 443.3 ± 61.6 m. Arterial blood gas analysis showed paO<span class="elsevierStyleInf">2</span> 73.1 ± 9.4 mmHg and paCO<span class="elsevierStyleInf">2</span> 39.7±5.0 mmHg.</p><p class="elsevierStylePara">Table 1. Baseline characteristics of patients’ sample.</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Variable</td><td>Mean</td><td>SD</td></tr><tr align="left"><td>Age (years)</td><td>62.5</td><td>9.5</td></tr><tr align="left"><td>Body mass Index</td><td>25.8</td><td>4.8</td></tr><tr align="left"><td>FEV 1 (L)</td><td>1.5</td><td>0.5</td></tr><tr align="left"><td>FEV 1 (%)</td><td>57.1</td><td>19.6</td></tr><tr align="left"><td>FVC (L)</td><td>2.8</td><td>0.6</td></tr><tr align="left"><td>FVC (%)</td><td>80.1</td><td>19.3</td></tr><tr align="left"><td>FEV1/FVC</td><td>53.2</td><td>0.1</td></tr><tr align="left"><td>DLCO (%)</td><td>59.8</td><td>19.9</td></tr><tr align="left"><td>PaO<span class="elsevierStyleInf">2</span> (mmHg)</td><td>73.1</td><td>9.4</td></tr><tr align="left"><td>PaCO<span class="elsevierStyleInf">2</span> (mmHg)</td><td>39.7</td><td>5.0</td></tr><tr align="left"><td>mMRC</td><td>1.9</td><td>1.1</td></tr><tr align="left"><td>6MWT (m)</td><td>443.3</td><td>61.6</td></tr></table><p class="elsevierStylePara">The number of patients in stages I–IV of COPD severity, as defined by GOLD,<a href="#bib2" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> showed that the majority of patients were GOLD stages II and III – 78% (<a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>). According to the mMRC scale 46% patients were class 2 (<a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>), with a mean value of 1.9 ± 1.1. Median BODE index of the patients was 2.8 ± 1.8 and 38% were BODE 1–4 (<a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>); considering BODE classes, 25 patients (50%) were class 1 and 17 (34%) class 2 (<a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>). Analysing CAT questionnaire, mean value of the score was 10.7 (±7.4) and about 80% of the patients had slight to medium impact on their quality of life (<a href="#t0010" class="elsevierStyleCrossRefs">Table 2</a>).</p><p class="elsevierStylePara">Table 2. Distribution of patiens according to GOLD spirometric stage, mMRC, BODE index scale and CAT.</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Variable</td><td><span class="elsevierStyleItalic">N</span></td><td>%</td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">GOLD</span></td></tr><tr align="left"><td>I</td><td>7</td><td>14</td></tr><tr align="left"><td>II</td><td>25</td><td>50</td></tr><tr align="left"><td>III</td><td>14</td><td>28</td></tr><tr align="left"><td>IV</td><td>4</td><td>8</td></tr><tr align="left"><td colspan="3"> </td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">mMRC</span></td></tr><tr align="left"><td>0</td><td>7</td><td>14</td></tr><tr align="left"><td>1</td><td>7</td><td>14</td></tr><tr align="left"><td>2</td><td>23</td><td>46</td></tr><tr align="left"><td>3</td><td>8</td><td>16</td></tr><tr align="left"><td>4</td><td>5</td><td>10</td></tr><tr align="left"><td colspan="3"> </td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">BODE score</span></td></tr><tr align="left"><td>0</td><td>4</td><td>8</td></tr><tr align="left"><td>1</td><td>10</td><td>20</td></tr><tr align="left"><td>2</td><td>11</td><td>22</td></tr><tr align="left"><td>3</td><td>7</td><td>14</td></tr><tr align="left"><td>4</td><td>10</td><td>20</td></tr><tr align="left"><td>5</td><td>4</td><td>8</td></tr><tr align="left"><td>6</td><td>2</td><td>4</td></tr><tr align="left"><td>7</td><td>2</td><td>4</td></tr><tr align="left"><td>8</td><td>0</td><td>0</td></tr><tr align="left"><td>9</td><td>0</td><td>0</td></tr><tr align="left"><td>10</td><td>0</td><td>0</td></tr><tr align="left"><td colspan="3"> </td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">BODE class</span></td></tr><tr align="left"><td>1</td><td>25</td><td>50</td></tr><tr align="left"><td>2</td><td>17</td><td>34</td></tr><tr align="left"><td>3</td><td>6</td><td>12</td></tr><tr align="left"><td>4</td><td>2</td><td>4</td></tr><tr align="left"><td colspan="3"> </td></tr><tr align="left"><td colspan="3"><span class="elsevierStyleItalic">CAT impact</span></td></tr><tr align="left"><td>Low</td><td>26</td><td>52</td></tr><tr align="left"><td>Medium</td><td>16</td><td>32</td></tr><tr align="left"><td>High</td><td>8</td><td>16</td></tr><tr align="left"><td>Very high</td><td>0</td><td>0</td></tr></table><p class="elsevierStylePara">Looking at patient distribution by age and CAT impact group, younger patients had higher CAT impact and mean age in the low impact group of patients was 62.1 ± 6.2 years; in the high impact group it was 46.3 ± 4.2 years, although this was not a significant difference. Also, in relation to BMI values and CAT impact, we did not find a statistically significant correlation (BMI in the low impact group 23.8 ± 7.0 kg/m<span class="elsevierStyleSup">2</span> and in the high impact group 25.3 ± 5.1 kg/m<span class="elsevierStyleSup">2</span>).</p><p class="elsevierStylePara">We found a positive correlation between CAT and BODE in our patients (96% male), whether considering CAT scores, CAT impact, BODE index score or BODE Index class – CAT score correlated positively with BODE index score (<span class="elsevierStyleItalic">R</span> 0.475, <span class="elsevierStyleItalic">p</span> < 0.01) – <a href="#f0005" class="elsevierStyleCrossRefs">Figure 1</a>, CAT score correlated positively with BODE index class (<span class="elsevierStyleItalic">R</span> 0.357, <span class="elsevierStyleItalic">p</span> 0.011), CAT impact correlated positively with BODE index score (<span class="elsevierStyleItalic">R</span> 0.377, <span class="elsevierStyleItalic">p</span> 0.004) and CAT impact correlated positively with BODE index class (<span class="elsevierStyleItalic">R</span> 0.326, <span class="elsevierStyleItalic">p</span> 0.021) – <a href="#f0010" class="elsevierStyleCrossRefs">Figure 2</a>.</p><a name="f0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385610fig1.jpg" alt="Correlation between CAT score and BODE index score (<i>R</i> 0.475, <i>p</i> 0.01)."></img></p><p class="elsevierStylePara">Figure 1. Correlation between CAT score and BODE index score (<span class="elsevierStyleItalic">R</span> 0.475, <span class="elsevierStyleItalic">p</span> 0.01).</p><a name="f0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"><img src="420v21n01-90385610fig2.jpg" alt="Correlation between CAT impact and BODE index class (<i>R</i> 0.315, <i>p</i> 0.026)."></img></p><p class="elsevierStylePara">Figure 2. Correlation between CAT impact and BODE index class (<span class="elsevierStyleItalic">R</span> 0.315, <span class="elsevierStyleItalic">p</span> 0.026).</p><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion</span><p class="elsevierStylePara">COPD is considered as a part of the “chronic systemic inflammatory syndrome” along with the metabolic syndrome, coronary artery disease and others<a href="#bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">24</span></a> and not only a respiratory disease. The complexity of COPD and its frequent co-morbidities<a href="#bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">25</span></a> requires assessment and staging of the disease beyond the degree of airflow limitation. Therefore, new GOLD guidelines<a href="#bib4" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a> suggest the assessment of the severity of COPD not only by FEV1 but also by symptom scoring (e.g., mMRC dyspnea scale or CAT score), and the frequency of acute exacerbations of COPD and these conceptual changes reinforce the importance of a good questionnaire in assessing the severity of COPD in clinical practice.</p><p class="elsevierStylePara">In our data, independently of the spirometric severity of COPD, the majority of patients have low to medium impact of disease using CAT, low mMRC values and good results in 6MWT, which are probably due to their inclusion in a Rehabilitation program. The positive results found in the 6MWT and mMRC also influence the score and class of the BODE index.</p><p class="elsevierStylePara">Few data are available for discussing the relationship between CAT and BODE and despite the good spirometry, the functional results of our patients and the male predominance, our data did find a correlation between CAT score and impact and BODE index in the evaluation of COPD severity and impact. The correlation between CAT scores and the BODE index, a documented practical instrument in predicting the severity and mortality in COPD population, endorses the use of CAT to characterize COPD patient quality of life.</p><p class="elsevierStylePara">Some limitations in our study should be addressed. This is a retrospective study in patients at a stable period of their COPD – longitudinal follow-up studies concerning the frequencies of subsequent hospitalization and COPD acute exacerbation and mortality are needed to measure the correlation between CAT and the BODE index better. The number of patients included in this study was quite small, the patients are of the same race and there were only 2 women included. Our data may also have been biased by the single medical-center-based patients: non-hospital patients may have different outcomes.</p><p class="elsevierStylePara">CAT is a short and valid tool for monitoring COPD health status and the correlation found in this study reinforces the discriminative validity of CAT and its importance as a complement in the evaluation of the true impact of COPD on patients’ daily lives. It is important to consider the use of CAT not only in patients assisted in hospitals but also in Primary Care.</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study.</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study received sufficient information and gave their written informed consent to participate in the study.</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.</p><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Authorship</span><p class="elsevierStylePara">Study design: IL, TG and NT; Data collection: IL, TG, AC and CR; Data analysis and interpretation: IL and TG; Critical revision of the manuscript: AC, CR, MG and NT.</p><a name="sec0070" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare.</p><p class="elsevierStylePara">Received 29 November 2013 <br></br>Accepted 22 February 2014 </p><p class="elsevierStylePara">Corresponding author. ines.ladeira@chvng.min-saude.pt</p>" "pdfFichero" => "320v21n01a90385611pdf001.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec640998" "palabras" => array:5 [ 0 => "BODE index" 1 => "CAT" 2 => "COPD" 3 => "Respiratory rehabilitation" 4 => "Quality of life" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><br/><p class="elsevierStylePara">Chronic Obstructive Pulmonary Disease (COPD) will be the 5th leading cause of disability (DALYs) and the 4th leading cause of death by 2030. Measuring the real impact of COPD using CAT (“COPD Assessment Test”) can complement BODE index, an indicator of mortality.</p><span class="elsevierStyleSectionTitle">Aims</span><br/><p class="elsevierStylePara">To assess correlation between CAT and BODE index in COPD patients.</p><span class="elsevierStyleSectionTitle">Materials and methods</span><br/><p class="elsevierStylePara">A retrospective study was conducted in a population of patients with COPD in a Respiratory Rehabilitation program. We analyzed demographic variables, variables in respiratory function – 6 min walking test (6MWT), post-BD forced expiratory volume in 1st second (FEV1%); dyspnea by mMRC scale; BODE Index and CAT.</p><span class="elsevierStyleSectionTitle">Results</span><br/><p class="elsevierStylePara">The study included 50 patients – GOLD stage I (7), II (25), III (14) and IV (4), 48 men; mean age 62.6 years (±9.5), average BMI 25.8 kg/m<span class="elsevierStyleSup">2</span> (±4.8) and FEV1 57.1% (±19.6); 6MWT of 443.3 m (±61.6); 46% patients in classes 2 and 3 of mMRC scale; 84% were class 2 in BODE Index. About 80% reported slight to medium impact in CAT. CAT score and impact were correlated with BODE index score: <span class="elsevierStyleItalic">R</span> = 0.475, <span class="elsevierStyleItalic">p</span> < 0.01, and <span class="elsevierStyleItalic">R</span> = 0.377, <span class="elsevierStyleItalic">p</span> = 0.004, and BODE index class: <span class="elsevierStyleItalic">R</span> = 0.357, <span class="elsevierStyleItalic">p</span> = 0.011, and <span class="elsevierStyleItalic">R</span> = 0.326, <span class="elsevierStyleItalic">p</span> = 0.021.</p><span class="elsevierStyleSectionTitle">Conclusion</span><br/><p class="elsevierStylePara">As pre-existent data in the literature (exacerbations and benefit of rehabilitation in COPD), the positive correlations found with BODE index reinforce the discriminative validity of CAT as a complement in the evaluation of what the true impact of COPD is on a patient's daily life.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385610fig1.jpg" "Alto" => 1308 "Ancho" => 1618 "Tamanyo" => 128978 ] ] "descripcion" => array:1 [ "en" => "Correlation between CAT score and BODE index score ( <span class="elsevierStyleItalic">R</span> 0.475, <span class="elsevierStyleItalic">p</span> 0.01)." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "420v21n01-90385610fig2.jpg" "Alto" => 1281 "Ancho" => 1640 "Tamanyo" => 154911 ] ] "descripcion" => array:1 [ "en" => "Correlation between CAT impact and BODE index class ( <span class="elsevierStyleItalic">R</span> 0.315, <span class="elsevierStyleItalic">p</span> 0.026)." ] ] 2 => array:5 [ "identificador" => "fig3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] 3 => array:5 [ "identificador" => "fig4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Updated projections of global mortality and burden of disease, 2002–2030: data sources, methods and results. 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Year/Month | Html | Total | |
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2024 November | 14 | 7 | 21 |
2024 October | 77 | 42 | 119 |
2024 September | 105 | 40 | 145 |
2024 August | 105 | 57 | 162 |
2024 July | 106 | 45 | 151 |
2024 June | 119 | 52 | 171 |
2024 May | 104 | 45 | 149 |
2024 April | 73 | 52 | 125 |
2024 March | 85 | 26 | 111 |
2024 February | 97 | 34 | 131 |
2024 January | 85 | 35 | 120 |
2023 December | 75 | 32 | 107 |
2023 November | 73 | 32 | 105 |
2023 October | 76 | 48 | 124 |
2023 September | 48 | 49 | 97 |
2023 August | 47 | 24 | 71 |
2023 July | 70 | 29 | 99 |
2023 June | 47 | 15 | 62 |
2023 May | 90 | 30 | 120 |
2023 April | 70 | 18 | 88 |
2023 March | 133 | 20 | 153 |
2023 February | 111 | 26 | 137 |
2023 January | 43 | 13 | 56 |
2022 December | 89 | 23 | 112 |
2022 November | 131 | 41 | 172 |
2022 October | 79 | 34 | 113 |
2022 September | 63 | 40 | 103 |
2022 August | 107 | 48 | 155 |
2022 July | 113 | 53 | 166 |
2022 June | 99 | 42 | 141 |
2022 May | 98 | 39 | 137 |
2022 April | 88 | 38 | 126 |
2022 March | 63 | 53 | 116 |
2022 February | 94 | 38 | 132 |
2022 January | 73 | 35 | 108 |
2021 December | 57 | 44 | 101 |
2021 November | 73 | 33 | 106 |
2021 October | 70 | 39 | 109 |
2021 September | 54 | 31 | 85 |
2021 August | 64 | 26 | 90 |
2021 July | 64 | 26 | 90 |
2021 June | 79 | 33 | 112 |
2021 May | 119 | 25 | 144 |
2021 April | 223 | 85 | 308 |
2021 March | 136 | 34 | 170 |
2021 February | 117 | 29 | 146 |
2021 January | 68 | 17 | 85 |
2020 December | 99 | 13 | 112 |
2020 November | 92 | 27 | 119 |
2020 October | 93 | 19 | 112 |
2020 September | 106 | 18 | 124 |
2020 August | 141 | 30 | 171 |
2020 July | 197 | 27 | 224 |
2020 June | 186 | 23 | 209 |
2020 May | 184 | 20 | 204 |
2020 April | 151 | 16 | 167 |
2020 March | 144 | 22 | 166 |
2020 February | 182 | 17 | 199 |
2020 January | 172 | 17 | 189 |
2019 December | 192 | 32 | 224 |
2019 November | 171 | 24 | 195 |
2019 October | 152 | 30 | 182 |
2019 September | 252 | 42 | 294 |
2019 August | 391 | 32 | 423 |
2019 July | 497 | 41 | 538 |
2019 June | 445 | 18 | 463 |
2019 May | 440 | 30 | 470 |
2019 April | 418 | 38 | 456 |
2019 March | 541 | 21 | 562 |
2019 February | 501 | 13 | 514 |
2019 January | 528 | 35 | 563 |
2018 December | 295 | 11 | 306 |
2018 November | 119 | 0 | 119 |
2018 October | 122 | 17 | 139 |
2018 September | 36 | 4 | 40 |
2018 August | 65 | 19 | 84 |
2018 July | 66 | 17 | 83 |
2018 June | 72 | 14 | 86 |
2018 May | 141 | 15 | 156 |
2018 April | 174 | 24 | 198 |
2018 March | 252 | 18 | 270 |
2018 February | 139 | 7 | 146 |
2018 January | 156 | 15 | 171 |
2017 December | 187 | 18 | 205 |
2017 November | 46 | 11 | 57 |
2017 October | 32 | 9 | 41 |
2017 September | 25 | 10 | 35 |
2017 August | 50 | 14 | 64 |
2017 July | 29 | 15 | 44 |
2017 June | 44 | 21 | 65 |
2017 May | 55 | 21 | 76 |
2017 April | 31 | 6 | 37 |
2017 March | 38 | 3 | 41 |
2017 February | 23 | 2 | 25 |
2017 January | 21 | 10 | 31 |
2016 December | 48 | 14 | 62 |
2016 November | 59 | 5 | 64 |
2016 October | 29 | 9 | 38 |
2016 September | 24 | 5 | 29 |
2016 August | 9 | 2 | 11 |
2016 July | 6 | 12 | 18 |
2016 June | 20 | 6 | 26 |
2016 May | 13 | 4 | 17 |
2016 April | 51 | 34 | 85 |
2016 March | 70 | 49 | 119 |
2016 February | 77 | 49 | 126 |
2016 January | 52 | 34 | 86 |
2015 December | 76 | 36 | 112 |
2015 November | 65 | 31 | 96 |
2015 October | 57 | 63 | 120 |
2015 September | 59 | 31 | 90 |
2015 August | 36 | 19 | 55 |
2015 July | 33 | 14 | 47 |
2015 June | 43 | 11 | 54 |
2015 May | 47 | 19 | 66 |
2015 April | 85 | 39 | 124 |
2015 March | 109 | 47 | 156 |
2015 February | 5 | 50 | 55 |