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Questionnaires in Multidimensional Assessment of Chronic Obstructive Pulmonary Disease: Two Sides of the Same Coin
Cuestionarios en la valoración multidimensional de la enfermedad pulmonar obstructiva crónica: dos caras de la misma moneda
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Michael Roberts" "autores" => array:1 [ 0 => array:2 [ "nombre" => "C. Michael" "apellidos" => "Roberts" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614001112" "doi" => "10.1016/j.arbres.2014.02.019" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001112?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001402?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001402/v1_201406290026/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Questionnaires in Multidimensional Assessment of Chronic Obstructive Pulmonary Disease: Two Sides of the Same Coin" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "265" "paginaFinal" => "266" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Luis López Campos, Carmen Calero" "autores" => array:2 [ 0 => array:4 [ "nombre" => "José Luis" "apellidos" => "López Campos" "email" => array:1 [ 0 => "lcampos@separ.es" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carmen" "apellidos" => "Calero" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Cuestionarios en la valoración multidimensional de la enfermedad pulmonar obstructiva crónica: dos caras de la misma moneda" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent decades, the diagnosis of chronic obstructive pulmonary disease (COPD) has been veering from simple one-dimensional schemes to more complex strategies based on multidimensional approaches or on phenotypes. The latest update of the GOLD<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> strategy recommends the use of three questionnaires for the assessment of the patient's situation: the COPD Assessment Test (CAT),<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the modified Medical Research Council (MRC) dyspnea scale,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and the Clinical COPD Questionnaire (CCQ).<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The inclusion of these three different questionnaires in the GOLD strategy to assess the impact of the disease in patients has provoked an interesting debate on the multidimensional assessment of the disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to verify the equivalence of these questionnaires, several authors have conducted observational studies, describing a reality that was intuitively perceived by the clinician: the results of these questionnaires, while individually valid in assessing the impact of the disease, are not superimposable. In this respect, some studies have highlighted a lack of agreement between CAT and MRC,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> while others report the discrepancies between the MRC and the St. George's respiratory questionnaire.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The differences are reduced by changing the cutoff for the MRC questionnaire in the GOLD classification. Thus, Jones et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> suggest that if patients with and without dyspnea (MRC grade 0) are separated, the distribution of patients over the various GOLD types is very similar to that obtained using CAT with the current cutoff values.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The idea behind these studies is that if the classification percentages with both scales in a given patient cohort agree, then they could all be used interchangeably for categorizing COPD patients. However, as Jones et al.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> point out, concordance in the distribution of GOLD types does not necessarily mean that patients who obtain the same scores on the different questionnaires using these new cutoff values will be exactly the same. In this respect, it should be borne in mind that epidemiological study results can rarely be applied to a particular patient. This phenomenon, called ecological fallacy, has been well described in the literature.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> In the case in hand, this phenomenon implies that, even if cutoff values result in similar percentages in a cohort of patients, significant differences can be detected when specific clinical cases are assessed, depending on the questionnaire used. For this reason, more studies with other methodological designs or types of analyses that allow evaluation of the use of different questionnaires and cutoff levels in individual patients, and not in patient cohorts, are needed.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of Archivos de Bronconeumología, Rieger-Reyes et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> present the results of an observational study in 283 COPD subjects evaluating the results of CAT and MRC questionnaires, administered the same day and by the same interviewer to each patient, in order to analyze their potential equivalence in the evaluation of a COPD patient. This study takes an interesting analytical approach, since it provides an assessment of patient-based results. Thus, the authors note that 72.8% of the patients were classified as the same GOLD type, whether assessed by MRC or CAT (75% for types A and B and 70.2% for types C and D). A next step for the authors might be to analyze the characteristics of those cases in whom the questionnaire results agree, as this might identify a particular type of patient in whom the choice of scale for multidimensional assessment would be of lesser relevance.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We are presently witnessing the birth of patient-focused medical practices that will likely lead to the introduction of personalized medicine in COPD in the coming years.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Multidimensional assessment initiatives such as the GOLD strategy and other similar approaches are the first step in a long journey, upon which we will learn as we go. Meanwhile, diagnostic strategies must be employed that allow us to adapt to the patients, their variable perception of symptoms, and the changeable clinical expression of the disease. In this context, more questionnaires might not be required; instead, a clear idea on how to use them in individual patients may need to be developed. Recalling a quote attributed to the poet, clergyman and dean of St. Patrick's Cathedral in Dublin, Jonathan Swift (1667–1745), the author of the literary work <span class="elsevierStyleItalic">Gulliver's Travels</span>, “We have just enough religion to make us hate, but not enough to make us love one another.” The better we understand the complex variability of COPD in individual patients, the better will we be able to provide more personalized treatment solutions, in accordance with advancing science and technology.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López Campos JL, Calero C. Cuestionarios en la valoración multidimensional de la enfermedad pulmonar obstructiva crónica: dos caras de la misma moneda. 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Idrovo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1289/ehp.1103444" "Revista" => array:5 [ "tituloSerie" => "Environ Health Perspect" "fecha" => "2011" "volumen" => "119" "paginaInicial" => "A332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21807591" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clasificación de la gravedad de la enfermedad pulmonar obstructiva crónica según la nueva guía Iniciativa Global para la Enfermedad Obstructiva Crónica 2011: COPD Assessment Test versus modified Medical Research Council" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Rieger-Reyes" 1 => "F.J. García-Tirado" 2 => "F.J. Rubio-Galán" 3 => "J.M. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 38 | 21 | 59 |
| 2024 September | 35 | 14 | 49 |
| 2024 August | 52 | 35 | 87 |
| 2024 July | 31 | 22 | 53 |
| 2024 June | 56 | 28 | 84 |
| 2024 May | 68 | 25 | 93 |
| 2024 April | 32 | 27 | 59 |
| 2024 March | 40 | 21 | 61 |
| 2024 February | 41 | 26 | 67 |
| 2023 March | 5 | 4 | 9 |
| 2023 February | 25 | 22 | 47 |
| 2023 January | 30 | 36 | 66 |
| 2022 December | 34 | 36 | 70 |
| 2022 November | 61 | 38 | 99 |
| 2022 October | 31 | 36 | 67 |
| 2022 September | 30 | 34 | 64 |
| 2022 August | 34 | 41 | 75 |
| 2022 July | 49 | 39 | 88 |
| 2022 June | 24 | 38 | 62 |
| 2022 May | 32 | 39 | 71 |
| 2022 April | 32 | 19 | 51 |
| 2022 March | 28 | 60 | 88 |
| 2022 February | 32 | 44 | 76 |
| 2022 January | 27 | 29 | 56 |
| 2021 December | 21 | 37 | 58 |
| 2021 November | 27 | 44 | 71 |
| 2021 October | 35 | 45 | 80 |
| 2021 September | 28 | 37 | 65 |
| 2021 August | 25 | 38 | 63 |
| 2021 July | 21 | 26 | 47 |
| 2021 June | 34 | 45 | 79 |
| 2021 May | 28 | 28 | 56 |
| 2021 April | 59 | 56 | 115 |
| 2021 March | 37 | 28 | 65 |
| 2021 February | 26 | 26 | 52 |
| 2021 January | 30 | 19 | 49 |
| 2020 December | 31 | 25 | 56 |
| 2020 November | 25 | 22 | 47 |
| 2020 October | 22 | 16 | 38 |
| 2020 September | 15 | 11 | 26 |
| 2020 August | 21 | 20 | 41 |
| 2020 July | 21 | 24 | 45 |
| 2020 June | 19 | 7 | 26 |
| 2020 May | 27 | 20 | 47 |
| 2020 April | 27 | 30 | 57 |
| 2020 March | 22 | 9 | 31 |
| 2020 February | 28 | 24 | 52 |
| 2020 January | 23 | 15 | 38 |
| 2019 December | 31 | 13 | 44 |
| 2019 November | 27 | 18 | 45 |
| 2019 October | 17 | 10 | 27 |
| 2019 September | 15 | 8 | 23 |
| 2019 August | 22 | 23 | 45 |
| 2019 July | 19 | 18 | 37 |
| 2019 June | 19 | 13 | 32 |
| 2019 May | 32 | 11 | 43 |
| 2019 April | 52 | 19 | 71 |
| 2019 March | 37 | 23 | 60 |
| 2019 February | 31 | 15 | 46 |
| 2019 January | 27 | 12 | 39 |
| 2018 December | 38 | 23 | 61 |
| 2018 November | 54 | 18 | 72 |
| 2018 October | 117 | 22 | 139 |
| 2018 September | 26 | 8 | 34 |
| 2018 May | 17 | 0 | 17 |
| 2018 April | 48 | 6 | 54 |
| 2018 March | 41 | 2 | 43 |
| 2018 February | 40 | 3 | 43 |
| 2018 January | 117 | 8 | 125 |
| 2017 December | 72 | 6 | 78 |
| 2017 November | 41 | 3 | 44 |
| 2017 October | 30 | 9 | 39 |
| 2017 September | 39 | 7 | 46 |
| 2017 August | 44 | 7 | 51 |
| 2017 July | 32 | 2 | 34 |
| 2017 June | 50 | 18 | 68 |
| 2017 May | 47 | 9 | 56 |
| 2017 April | 41 | 11 | 52 |
| 2017 March | 38 | 3 | 41 |
| 2017 February | 26 | 5 | 31 |
| 2017 January | 28 | 4 | 32 |
| 2016 December | 34 | 7 | 41 |
| 2016 November | 46 | 8 | 54 |
| 2016 October | 43 | 20 | 63 |
| 2016 September | 46 | 16 | 62 |
| 2016 August | 50 | 14 | 64 |
| 2016 July | 27 | 4 | 31 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 38 | 2 | 40 |
| 2015 September | 28 | 8 | 36 |
| 2015 August | 41 | 5 | 46 |
| 2015 July | 28 | 14 | 42 |
| 2015 June | 31 | 3 | 34 |
| 2015 May | 43 | 12 | 55 |
| 2015 April | 27 | 11 | 38 |
| 2015 March | 30 | 3 | 33 |
| 2015 February | 23 | 5 | 28 |
| 2015 January | 21 | 9 | 30 |
| 2014 December | 19 | 10 | 29 |
| 2014 November | 20 | 4 | 24 |
| 2014 October | 47 | 16 | 63 |
| 2014 September | 1 | 0 | 1 |
| 2014 August | 0 | 2 | 2 |
| 2014 July | 1 | 0 | 1 |
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