Assessing symptom burden in patients with advanced COPD – Is CAT enough?

Abstract

Background: CAT (COPD Assessment Test) is a validated tool to assess the impact of COPD symptoms. Edmonton Symptom Assessment Scale (ESAS) was developed to assess common symptoms in palliative care patients (pain, tiredness, nausea, depression, anxiety, drowsiness, appetite disturbance, poor well being and shortness of breath). ESAS may help identify and quantify significant non-respiratory symptoms in this population and guide palliative care. Aims: 1) To assess prevalence and severity of symptoms in patients with severe COPD using both CAT and ESAS 2) To assess if CAT/ESAS correlate with mortality in order to target advance care planning (ACP) in this population. Method: Patients with severe COPD (MRC grade 4-5 breathlessness ± FEV Results: Mean age 69.7. Mean FEV1 = 43% predicted (SD ± 13.7). Mean CAT score was high 28 (SD ±7.3). 4 patients died within 12 months of attendance. There was no significant trend between CAT and ESAS scores. Patients reported, along with breathlessness, high levels of tiredness, low wellbeing and anxiety. There was large variation in drowsiness, pain and nausea scores. CAT >30 and ESAS >50 were associated with mortality at 12 months in this small population. Conclusions: ESAS delineated significant symptom burden not accounted for in CAT assessment of patients with advanced COPD. A broader assessment tool such as ESAS in combination with conventional measures (CAT, FEV1 and MRC grade) is advocated in a holistic approach to palliating end stage COPD and may help target ACP.