Physical Activity Characteristics across GOLD Quadrants Depend on the Questionnaire Used

Background The GOLD multidimensional classification of COPD severity combines the exacerbation risk with the symptom experience, for which 3 different questionnaires are permitted. This study investigated differences in physical activity (PA) in the different GOLD quadrants and patient's distribution in relation to the questionnaire used. Methods 136 COPD patients (58+/- 21% FEV1 predicted, 34F/102M) completed COPD assessment test (CAT), clinical COPD questionnaire (CCQ) and modified Medical Research Council (mMRC) questionnaire. Exacerbation history, spirometry and 6MWD were collected. PA was objectively measured for 2 periods of 1 week, 6 months apart, in 5 European centres; to minimise seasonal and clinical variation the average of these two periods was used for analysis. Results GOLD quadrants C+D had reduced PA compared with A+B (3824 [2976] vs. 5508 [4671] steps. d-1, p<0.0001). The choice of questionnaire yielded different patient distributions agreement mMRC-CAT kappa = 0.57; CCQ-mMRC kappa = 0.71; CCQ-CAT kappa = 0.72) with different clinical characteristics. PA was notably lower in patients with an mMRC score >= 2 (3430 [2537] vs. 5443 [3776] steps. d(-1), p < 0.001) in both the low and high risk quadrants. Conclusions Using different questionnaires changes the patient distribution and results in different clinical characteristics. Therefore, standardization of the questionnaire used for classification is critical to allow comparison of different studies using this as an entry criterion.