RESUMEN
A survey of pulmonologists attending a clinical meeting of the Saudi Thoracic Society found that only 55% of responders considered that inhaled corticosteroids [ICS] had a positive effect on quality of life in Chronic Obstructive Pulmonary Disease [COPD]. Why the divergence of opinion when all the guidelines have concluded that ICS improve quality of life and produce significant bronchodilation? ICS unequivocally reduce the rate of exacerbations by a modest 20%, but this does not extend to serious exacerbations requiring hospitalization. Bronchodilatation with ICS is now documented to be restricted to some phenotypes of COPD. Withdrawal of ICS trials reported a modest decline of FEV[1] [<5%] in half the studies and no decline in the other half. In spite of the guidelines statements, there is no concurrence on whether ICS improve the quality of life and there is no conclusive evidence that the combination of long-acting B2 agonists [LABA] with ICS is superior to LABA alone in that regard. The explanation for these inconclusive results may be related to the fact that COPD consists of three different phenotypes with divergent responses to LABA and ICS. Therapy tailored to phenotype is the future for COPD
RESUMEN
To produce a conceptually equivalent Arabic version of the Chronic Obstructive Pulmonary Disease [COPD] Assessment Test [CAT], and to assess its reliability. A prospective observational study was carried out from June 2010 to September 2010 at King Abdulaziz Medical City and King Khalid University Hospital, Riyadh, Saudi Arabia. We conducted this study in 2 phases. Phase 1: the translation of the CAT from English to Arabic, through forward and backward translation, as well as pilot testing. Phase 2: assessment of the test-retest reliability of the CAT for 45 patients with COPD who received optimal care by their pulmonologist. This study was conducted on 45 participants. The CAT mean total [ +/- SD] score at the test session was 10.7 +/- 5.8, and 9.2 +/- 4.5 at the re-test session. The interclass correlation of the total score was 0.9 [p=0.000076]. The strongest correlation was for the item of confidence in leaving home with a value of 0.92 [p=0.000082], whereas the weakest was for the item related to sleep with a value of 0.53 [p=0.007]. The Arabic version of the CAT was found to be easy to administer, reliable, and had a strong interclass correlation reflecting stability over time and across the items