Abstract
BackgroundThe COPD Assessment Test (CAT) contains eight items (cough, phlegm, chest tightness, breathlessness, limited activities, confidence leaving home, sleeplessness and energy). The current study aimed 1) to better understand the impact of the respiratory and non-respiratory CAT item scores on the CAT total score; and 2) to determine the impact of pulmonary rehabilitation (PR) on CAT items and CAT total score.MethodsCAT total score of ≥10 or ≥ 18 points was used to classify patients as highly symptomatic, a decrease of 2 points was considered as clinically relevant improvement. ‘Cough’, ‘phlegm’, ‘chest tightness’, ‘breathlessness’ were defined as respiratory items; ≥3 points on each item was defined as highly symptomatic.ResultsIn total, 497 clinically stable patients (55% male, age 64.0 (57.5–71.0) years, FEV1 46.0 (32.0–63.0)% predicted, CAT total score 22.0 (17.5–26.0) points) were included. 95% had CAT score ≥ 10 points and 75% ≥18 points. Respectively, 45% and 54% of subjects scored high on 3 or 4 of the respiratory CAT items. Following PR, 220 patients (57.7%) reported an improved health status as assessed by CAT total score (− 3.0 (− 7.0–1.0) points). Change in CAT item scores ranged from 0.0 (− 1.0–0.0) to − 1.0 (− 2.0–0.0) points) with best improvements in ‘energy’ (− 1.0 (− 2.0–0.0)points).ConclusionsA substantial number of patients classified as highly symptomatic did not report a high level of respiratory symptoms, indicating that non-respiratory symptoms impact on disease classification and treatment algorithm. The impact of PR on CAT item scores varied by individual item.Trial registrationNetherlands National Trial Register (NTR3416). Registered 2 May 2012.
Highlights
The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) contains eight items
Patients had moderate to severe airflow obstruction and were highly symptomatic; 94% of the patients were classified in Global initiative for chronic Obstructive Lung Disease (GOLD) B or D
The current study investigated the impact of respiratory as well as non-respiratory symptoms on the COPD Assessment Test (CAT) total score as well as the impact of pulmonary rehabilitation (PR) on the eight CAT items
Summary
The COPD Assessment Test (CAT) contains eight items (cough, phlegm, chest tightness, breathlessness, limited activities, confidence leaving home, sleeplessness and energy). Health status can be measured in patients with COPD using the COPD Assessment Test (CAT) [2]. It remains unknown whether and to what extent the eight CAT items are related to the CAT total score. This is potentially clinically important information, as the CAT total score determines the GOLD classification of patients with COPD and, in turn, the recommended pharmacological treatment strategy [1]. In theory, patients with COPD can have a CAT total score of 10 points or higher not directly related to their respiratory condition, such as sleep disturbance and lack of energy, which are most probably not directly affected by the currently available respiratory drug therapies
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