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Identifying Abnormal Exertional Breathlessness in COPD : Comparing Modified Medical Research Council and COPD Assessment Test With Cardiopulmonary Exercise Testing

Ekström, Magnus LU orcid ; Lewthwaite, Hayley ; Li, Pei Zhi ; Bourbeau, Jean ; Tan, Wan C. and Jensen, Dennis (2025) In Chest 167(3). p.697-711
Abstract

Background: COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both. Research Question: What are the abilities of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD? Study Design and Methods: Analysis of people aged ≥ 40 years with FEV1 to FVC ratio of < 0.70 after bronchodilator administration and ≥ 10 pack-years of smoking from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg scale 0-10) intensity rating more than the upper limit of normal at... (More)

Background: COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both. Research Question: What are the abilities of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD? Study Design and Methods: Analysis of people aged ≥ 40 years with FEV1 to FVC ratio of < 0.70 after bronchodilator administration and ≥ 10 pack-years of smoking from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg scale 0-10) intensity rating more than the upper limit of normal at the symptom-limited peak of CPET using normative reference equations. Results: We included 318 people with COPD (40% female) with a mean (SD) age of 66.5 (9.3) years and FEV1 of 79.5% predicted (19.0% predicted); 26% showed abnormally low exercise capacity (peak oxygen uptake less than the lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC score of 0 and CAT score of < 10, respectively. An mMRC score of ≥ 2 and CAT score of ≥ 10 was most specific (95%) to detect abnormal exertional breathlessness, but showed low sensitivity of only 12%. Accuracy for all scale cutoffs or combinations was < 65%. Compared with people with true-negatives findings, people with abnormal exertional breathlessness but low mMRC score, low CAT scores (false-negatives findings), or both showed worse self-reported and physiologic outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to be taking any respiratory medication (37% vs 30%; mean difference, 6.1%; 95% CI, –7.2 to 19.4; P=.36). Interpretation: In COPD, mMRC and CAT showed low concordance with CPET and failed to identify many people with abnormally high exertional breathlessness. Clinical Trial Registry: ClinicalTrials.gov; No.: NCT00920348; URL: www.clinicaltrials.gov

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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
dyspnea, exercise capacity, exercise test, reference values
in
Chest
volume
167
issue
3
pages
15 pages
publisher
American College of Chest Physicians
external identifiers
  • scopus:85217448928
  • pmid:39490971
ISSN
0012-3692
DOI
10.1016/j.chest.2024.10.027
language
English
LU publication?
yes
id
a0dbc6af-2ce3-4b3e-869d-a26a32af2362
date added to LUP
2025-04-09 11:35:30
date last changed
2025-04-23 12:01:07
@article{a0dbc6af-2ce3-4b3e-869d-a26a32af2362,
  abstract     = {{<p>Background: COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both. Research Question: What are the abilities of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD? Study Design and Methods: Analysis of people aged ≥ 40 years with FEV<sub>1</sub> to FVC ratio of &lt; 0.70 after bronchodilator administration and ≥ 10 pack-years of smoking from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg scale 0-10) intensity rating more than the upper limit of normal at the symptom-limited peak of CPET using normative reference equations. Results: We included 318 people with COPD (40% female) with a mean (SD) age of 66.5 (9.3) years and FEV<sub>1</sub> of 79.5% predicted (19.0% predicted); 26% showed abnormally low exercise capacity (peak oxygen uptake less than the lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC score of 0 and CAT score of &lt; 10, respectively. An mMRC score of ≥ 2 and CAT score of ≥ 10 was most specific (95%) to detect abnormal exertional breathlessness, but showed low sensitivity of only 12%. Accuracy for all scale cutoffs or combinations was &lt; 65%. Compared with people with true-negatives findings, people with abnormal exertional breathlessness but low mMRC score, low CAT scores (false-negatives findings), or both showed worse self-reported and physiologic outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to be taking any respiratory medication (37% vs 30%; mean difference, 6.1%; 95% CI, –7.2 to 19.4; P=.36). Interpretation: In COPD, mMRC and CAT showed low concordance with CPET and failed to identify many people with abnormally high exertional breathlessness. Clinical Trial Registry: ClinicalTrials.gov; No.: NCT00920348; URL: www.clinicaltrials.gov</p>}},
  author       = {{Ekström, Magnus and Lewthwaite, Hayley and Li, Pei Zhi and Bourbeau, Jean and Tan, Wan C. and Jensen, Dennis}},
  issn         = {{0012-3692}},
  keywords     = {{dyspnea; exercise capacity; exercise test; reference values}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{697--711}},
  publisher    = {{American College of Chest Physicians}},
  series       = {{Chest}},
  title        = {{Identifying Abnormal Exertional Breathlessness in COPD : Comparing Modified Medical Research Council and COPD Assessment Test With Cardiopulmonary Exercise Testing}},
  url          = {{http://dx.doi.org/10.1016/j.chest.2024.10.027}},
  doi          = {{10.1016/j.chest.2024.10.027}},
  volume       = {{167}},
  year         = {{2025}},
}