Features of COPD patients by comparing CAT with mMRC: a retrospective, cross-sectional study

BackgroundThe COPD (chronic obstructive pulmonary disease) assessment test (CAT) is a recently introduced, simple to use health status instrument, which takes less time to complete than better-established health status instruments...

ABSTRACTIntroduction:Chronic obstruction pulmonary disease (COPD) is a chronic airflow disorder along with decreasing health status. COPD assessment test (CAT) is commonly used to assess the health status of patients and their medical results. The aim of this study was to assess the therapeutic outcomes in patients with COPD using CAT in private hospitals in Yogyakarta.Materials and Methods:This was a cross-sectional study involving 156 patients, aged >40 years who had completed the CAT questionnaire. CAT scores were categorized into four groups and consisted of eight items: cough, phlegm, chest tightness, breathlessness going up hills/stairs, activity limitations at home, confidence leaving home, sleep, and energy. The four categories were successful therapy (CAT scores <10), moderately successful CAT 10–19), less successful (CAT scores 20–30), and unsuccessful (CAT score >30). The study was conducted from April to August 2018 at two Private Hospitals in Yogyakarta followed by descriptive-analytical data processing and chi-square analysis.Results:The therapeutic outcomes of COPD were 30.13% successful (CAT score: <10), 60.26% moderately successful (CAT score: 10–19), 9.62% less successful (CAT score: 20–30), and there were no patients with unsuccessful therapy. The majority of patients had moderate airflow severity. Exacerbation condition, severity level, and type of therapy showed a significant result (P < 0.05) toward therapy results with COPD measurement, and from eight CAT items, it was identified that 37.8% of respondents had breathlessness going up hills/stairs.Conclusion:CAT can assess the therapeutic outcomes and COPD patient’s health status with moderately successful therapy (CAT score 10–19) in more than sixty percent of respondents.

PurposeInhaler therapy is the mainstay of chronic obstructive pulmonary disease (COPD) management. Poor adherence causes disease exacerbation and affects patient mortality. Although the Adherence Starts with Knowledge-20 (ASK-20) questionnaire is a reliable tool for assessing medication adherence, the relationship between the ASK-20 and clinical factors in patients with COPD remains unknown. We investigated the relationship between the ASK-20 and clinical factors, and assessed real-world inhaler therapy use.Patients and MethodsA multicenter, cross-sectional study of outpatients with COPD undergoing inhaler treatment who completed the ASK-20 questionnaire was performed. We investigated COPD-related health status using the COPD Assessment Test (CAT), psychological status using the Hospital Anxiety and Depression Scale (HADS-anxiety and HADS-depression), respiratory function, patient satisfaction levels, and real-world inhaler therapy use.ResultsOf the total 319 patients, 87% were male with a median age of 74 years. Most patients had mild or moderate COPD, according to Global Initiative for Chronic Obstructive Lung Disease stage. The total ASK-20 scores correlated significantly with the CAT, HADS-anxiety, and HADS-depression scores (r = 0.27, 0.33, and 0.29, respectively, p < 0.01). Multivariable analysis showed that CAT and HADS-anxiety scores had an independent and significant impact on the ASK-20 scores [β, standardized regression coefficient: 0.18 (95% CI, 0.03–0.35; p = 0.02), and 0.29 (95% CI, 0.17–0.42; p < 0.01), respectively]; however, the ASK-20 scores were not correlated with age, sex, body mass index, cohabitation, modified Medical Research Council Dyspnea Scale score, pulmonary function, disease duration, number of COPD exacerbations per year, comorbidities, inhaler numbers, nor inhaler components.ConclusionThe ASK-20 scores in patients with COPD were significantly associated with CAT and HADS scores. In Japan, Respimat was prescribed to younger patients and patients with lower CAT scores. The ASK-20, a simple evaluation method, is useful for identifying clinical factors affecting adherence in patients with COPD.

Introduction: Chronic Obstructive Pulmonary Disease (COPD), a globally prevalent disease holds a huge stake among all pulmonary patients being admitted throughout the year. Various disease specific and health related quality of life questionnaires such as the Constructed Response Question (CRQ) and St. George’s Respiratory Questionnaire (SGRQ) are readily available, although, attributing to their complex structure, they can’t be used in a widespread manner. Some new scores like COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) were developed to ease-off this dilemma. However, there is a need to justify usage of these patient-friendly simplified scores by objectifying their inter-score reliability and correlation with disease severity and progression using statistical analysis. Aim: To analyse efficacious use of CAT, CCQ score and modified Medical Research Council (mMRC) scale in assessing health status of COPD with exacerbation. Additionally, it was also targeted to assess the inter-score correlation and reliability. Materials and Methods: A total of 180 confirmed cases of COPD with exacerbation were included in this study and subjected to requisite biochemical parameters, assessment scores at their admission, after 1 week and then after 4-6 week (at stabilisation) and spirometry. 136 patients were followed-up to 4-6 weeks and studied. Quantitative and qualitative variables thus obtained were compared statistically to find out correlation, if any. A p-value of &lt;0.05 was considered significant. Results: Mean difference between CAT score at exacerbation and at 1 week and CAT score at exacerbation and at 4-6 weeks were statistically significant. The changes in CCQ scores from exacerbation to 1 week and 6 weeks were also found to be statistically significant. Similar pattern was also observed in assessing timescale variability of mMRC score. There was good correlation between CAT, CCQ and mMRC scores at exacerbation, 1 week and it continually intensified as patients progressed towards a more stable state (4-6 weeks). Similar pattern was also observed with significant progressive positive correlation between change in CAT, CCQ and mMRC scores from exacerbation to 1 week and from exacerbation to 4-6 weeks. Conclusion: These score have a high correlative reliability when used to assess health status among various stages of disease from exacerbation towards a stable state. Similarly, correlation between change of individual score from exacerbation towards recovery state was also high.

Objective:In this study, we aimed to investigate the compatibility of modified Medical Research Council (mMRC) and COPD assessment test (CAT) scores of chronic obstructive pulmonary disease (COPD) patients in terms of evaluation of their symptom status.Methods:The study was planned as a single-center, cross-sectional study. Statistically four separate receiver operating characteristic (ROC) curves of CAT scoring were generated for mMRC scores of 1 to 4.Results:Two hundred twenty eight patients with stable COPD, mean age 64.2±8.2 and 88.6% male were included. A strong positive correlation was detected between CAT and mMRC (r=0.60, p<0.001). However, it was observed that 32 patients had mMRC<2 but CAT≥10, while 21 patients had CAT<10 but mMRC≥2. Thus, in 53 patients CAT and mMRC scores were not identical in terms of assessed symptom status. According to the ROC analysis, the mMRC scores of 1 to 4 were most compatible with the CAT scores of 10, 10, 15, and 20, respectively.Conclusions:Expanding current data represents that CAT score of 10 could be more compatible with mMRC score of 1. Moreover we think although a high mMRC or CAT score may be sufficient to assign patients to high symptom groups, it is needed to evaluate mMRC and CAT together to assign a patient to a low symptom group. In this way misclassification of the patients with high symptoms due to insufficient symptom evaluation as if they have low symptoms can be prevented.

Objective To observe the correlation between chronic obstructive pulmonary disease(COPD)assessment test (CAT)score and prognostic factors,so as to investigate the value of CAT score in predicting the prognosis of COPD. Methods A total of 81patients with newly diagnosed COPD in our hospital during Jul.2011to Sep.2012,without using inhaled corticosteroid(ICS)/long-actingβ2agonist(LABA)or long-acting antimuscarinic agent(LAMA),were divided into group A (low risk,less symptoms),B (low risk,more symptoms),C (high risk,less symptoms)and D (high risk,more symptoms)groups according to Global Initiative for Chronic Obstructive Lung Disease(GOLD,2011edition),and the patients were given ICS/LABA or ICS/LABA+LAMA treatment for 3months.The CAT score,age,smoking quantity,pulmonary function indices,body mass index (BMI),6-min walking distance (6MWD),modified medical British research council (mMRC)dyspnea scale,and the times of acute exacerbation of COPD (AECOPD)in previous one year were collected before and after treatment.The clinical characteristics analysis and correlation analysis were performed.Results The average age of the 81COPD patients was (66.27±8.52)years,with 88.89% being males and 85.19% having smoking history.The proportions of group A,B,C and D were 8.64%,30.86%,4.94%and 55.56% before treatment,respectively.The values of the forced expiratory volume in one second (FEV1),predicted amount as a percentage of FEV1(FEV1%Pred),forced vital capacity(FVC),predicted amount as a percentage of FVC (FVC%Pred),peak expiratory flow (PEF),predicted amount as a percentage of PEF(PEF%Pred),and 6MWD in CAT score≥10groups were significantly less than those in CAT score10 group(P0.05).The above parameters were not significantly different between patients with CAT score being 10-20,20- 30and≥30groups.mMRC scale and times of AECOPD in CAT score≥20groups were significantly higher than those in CAT score10group(P0.05).No significant difference in FEV1/FVC was found in different CAT score groups.The CAT score was significantly correlated with mMRC scale(pre-treatment r2=0.417,P0.001;post-treatment r2=0.19,P0.001), 6MWD (pre-treatment r2=0.320,P0.001;post-treatment r2=0.19,P0.001),pre-treatment FEV1(r2=0.177,P= 0.001 5),FEV1%Pred(r2=0.125,P=0.002),PEF(r2=0.164,P=0.002 4),PEF%Pred(r2=0.129,P=0.007 6),FVC (r2=0.098,P=0.021),FVC%Pred(r2=0.094,P=0.024),FEV1/FVC(r2=0.101,P=0.005 7),and AECOPD number (r2=0.059,P=0.028);and not correlated with the quantity of smoking (r2=0.041,P=0.083),BMI(r2=0.00,P= 0.89),and post-treatment FEV1(r2=0.01,P=0.22)or FEV1%Pred(r2=0.003,P=0.09).Conclusion COPD is prone to occur in the male smokers,with the highest proportion found in group D.CAT score has a good correlation with pre-and post -treatment mMRC scale and exercise capacity,suggesting it has a potential for predicting prognosis of COPD.

Background“Overlap syndrome” refers to obstructive sleep apnea (OSA) combined with chronic obstructive pulmonary disease (COPD), and has poorer outcomes than either condition alone. We aimed to evaluate the prevalence and possible predictors of overlap syndrome and its association with clinical outcomes in patients with COPD.MethodsWe assessed the modified Medical Research Council dyspnea scale (mMRC), Epworth sleepiness scale (ESS), COPD assessment test (CAT), Hospital Anxiety and Depression Scale (HADS), Charlson Comorbidity Index (CCI), and STOP-Bang questionnaire (SBQ) and performed spirometry and full overnight polysomnography in all patients. An apnea–hypopnea index (AHI) ≥ 5 events per hour was considered to indicate OSA. Risk factors for OSA in COPD patients were identified by univariate and multivariate logistic regression analyses.ResultsA total of 556 patients (66%) had an AHI ≥ 5 events per hour. There were no significant differences in age, sex ratio, mMRC score, smoking index, number of acute exacerbations and hospitalizations in the last year, and prevalence of cor pulmonale between the two groups (all p > 0.05). Body mass index (BMI), neck circumference, CAT score, CCI, ESS, HADS, and SBQ scores, forced expiratory volume (FEV)1, FEV1% pred, FEV1/forced vital capacity ratio, and prevalence of hypertension, coronary heart disease, and diabetes were all significantly higher and the prevalence of severe COPD was significantly lower in the COPD-OSA group compared with the COPD group (p < 0.05). BMI, neck circumference, ESS, CAT, CCI, HADS, hypertension, and diabetes were independent risk factors for OSA in COPD patients (p < 0.05). SBQ could be used for OSA screening in patients with COPD. Patients with severe COPD had a lower risk of OSA compared with patients with mild or moderate COPD (β = − 0.459, odds ratio = 0.632, 95% confidence interval 0.401–0.997, p = 0.048).ConclusionPatients with overlap syndrome had a poorer quality of life, more daytime sleepiness, and a higher prevalence of hypertension and diabetes than patients with COPD alone. BMI, neck circumference, ESS, CAT, CCI, HADS, hypertension, and diabetes were independent risk factors for OSA in patients with COPD. The risk of OSA was lower in patients with severe, compared with mild or moderate COPD.

RationaleFrailty in chronic obstructive pulmonary disease (COPD) patients has been associated with a higher rate of incidents, longer duration of hospitalization, poorer quality of life, and higher mortality.ObjectiveTo measure the prevalence of frailty among COPD patients and to evaluate associated variables.MethodsA cross-sectional study. Subjects who visited a State Center for High-Cost Medicines to obtain free monthly COPD medicines were considered eligible. Individuals ≥40 years old who had a FEV1/FVC ratio of <0.7 post-bronchodilation were enrolled. The Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale, Medical Research Council dyspnea scale (MRC), COPD Assessment Test (CAT), a combination of CAT/MRC [(CAT/8)+MRC], and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) severity scale were used to evaluate the enrolled subjects. Variables associated with frailty were analyzed using an ordered logistic regression and a multivariate logistic regression.ResultsThe prevalence of frailty and pre-frailty among the 153 COPD subjects enrolled was 50.3% (77/153) and 35.3% (54/153), respectively. Frailty scores were correlated with CAT (correlation coefficient [cc]: 0.52, p <0.001) and MRC (cc: 0.48, p <0.001). Ordinal regression models showed that MRC and CAT were associated with fragility (p <0.0001 for both models). Higher odds of frailty were observed in GOLD groups B (p = 0.04) and D (p = 0.02). Multiple logistic regression revealed that the combination CAT/MRC≥5.5 was associated with frailty (OR 6.73; p <0.0001) and had a specificity of 80.3%, sensitivity of 62.3%, and positive and negative predictive values of 76.2% and67.8%, respectively.ConclusionFrailty prevalence was high and was correlated with higher MRC and CAT scores. The CAT/MRC combination [(CAT/8)+MRC] ≥5.5 was highly associated with frailty, suggesting that an additional specific evaluation for the presence of frailty is indicated.

Comparisons of health status scores with MRC grades in COPD: implications for the GOLD 2011 classification

COPD EXACERBATION RATE BY BASELINE COPD ASSESSMENT TEST SCORE IN THE DYNAGITO STUDY

Purpose Our study aimed to compare the predictive value of the COPD Assessment Test (CAT) score at baseline and short-term change in CAT for future exacerbations in chronic obstructive pulmonary disease (COPD) patients. Methods This was a multicentre prospective study. Patients with COPD were recruited into the study and followed up for one year. CAT score and exacerbation in the previous year were collected at baseline. Change in CAT was defined as CAT score changing between baseline and the 6-month follow-up. Exacerbation was recorded during the one-year follow-up from 0th to 12th month. Result A total of 536 patients were enrolled for final analysis. The mean baseline CAT score was 14.5 ± 6.6 and the median (IQR) change in CAT was −2 (8). On Cox regression analysis, baseline CAT score, change in CAT and history of exacerbation were independent risk factors for exacerbation in the one-year follow-up. Compared with the r value of correlation between baseline CAT score and frequency of exacerbations during the one-year follow-up (r = 0.286, p < .001), that correlation between the change in CAT and frequency of exacerbations during follow-up was higher (r = 0.421, p < .001). The receiver operating characteristic (ROC) curves showed that change in CAT had a better predictive capacity for future exacerbation than baseline CAT (0.789 versus 0.609, p = .001). The ROC showed that change in CAT also had a better predictive capacity for future exacerbation than exacerbation in the previous year (0.789 versus 0.689, p = .011). Conclusion The correlation between baseline CAT score and future exacerbation was weak, however, the correlation between change in CAT and future exacerbation was moderate. Change in CAT in the short term had a better predictive value for future exacerbations of COPD than baseline CAT and exacerbation in the previous year.

Chronic obstructive pulmonary disease (COPD) frequently coexists with other chronic diseases, namely comorbidities. They negatively impact prognosis, exacerbations and quality of life in COPD patients. However, no studies have been performed to explore the impact of these comorbidities on COPD clinical control criteria. Determine the relationship between individualized comorbidities and COPD clinical control criteria. Observational, multicenter, cross-sectional study performed in Spain involving 4801 patients with severe COPD (< 50 predicted forced expiratory volume in the first second [FEV1%]). Clinical control criteria were defined by the combination of COPD assessment test (CAT) scores (≤16 vs ≥17) and exacerbations in the previous three months (none vs ≥1). Binary logistic regression adjusted by age and FEV1% was performed to identify comorbidities potentially associated with the lack of control of COPD. Secondary endpoints were the relationship between individualized comorbidities with COPD assessment test and exacerbations within the last three months. Most frequent comorbidities were arterial hypertension (51.2%), dyslipidemia (36.0%), diabetes (24.9%), obstructive sleep apnea-hypopnea syndrome (14.9%), anxiety (14.1%), heart failure (11.6%), depression (11.8%), atrial fibrillation (11.5%), peripheral arterial vascular disease (10.4%) and ischemic heart disease (10.1%). After age and FEV1% adjustment, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; all p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; all p < 0.001), sleep disorders (p < 0.0001), anemia (p = 0.015) and gastroesophageal reflux (p < 0.0001). These comorbidities were also related to previous exacerbations and COPD assessment test scores. Comorbidities are frequent in patients with severe COPD, negatively impacting COPD clinical control criteria. They are related to health-related quality of life measured by the COPD assessment test. Our results suggest that comorbidities should be investigated and treated in these patients to improve their clinical control. Study question: What is the impact of comorbidities on COPD clinical control criteria? Among 4801 patients with severe COPD (27.5% controlled and 72.5% uncontrolled), after adjustment by age and FEV1%, comorbidities related to lack of clinical control were cardiovascular diseases (heart failure, peripheral vascular disease and atrial fibrillation; p < 0.0001), psychologic disorders (anxiety and depression; p < 0.0001), metabolic diseases (diabetes, arterial hypertension and abdominal obesity; p < 0.001), obstructive sleep apnea-hypopnea syndrome (p < 0.0001), anaemia (p = 0.015) and gastroesophageal reflux (p < 0.0001), which were related to previous exacerbations and COPD assessment test scores. Comorbidities are related to health-related quality of life measured by the COPD assessment test scores and history of exacerbations in the previous three months.

Objective To explore the association between familial aggregation and lung function damage and COPD Assessment Test (CAT) scores in patients with chronic obstructive pulmonary disease (COPD), and the correlation between lung function damage and CAT scores. Methods A prospective analysis was conducted on the patients with COPD in Shengjing Hospital of China Medical University from January 2016 to May 2017.The diagnostic criteria were in line with the 2017 global chronic obstructive pulmonary disease initiative.The gender, age, body mass index, smoking index and family history of the subjects were recorded.The case group was divided into a family history group and a no family history group.CAT score test and lung function test are performed on all subjects (including pulse forced oscillation, plethysmography, pulmonary ventilation, dispersion function detection). We analyzed the association between familial aggregation and lung function and CAT scores in the 2 groups, and the correlation between lung function and CAT scores. Results ①A total of 102 cases were included in the case group, among them, 59 cases were in the family history group (accounting for 57.84%), 43 cases were in the no family history group (accounting for 42.16%). There was no statistically significant difference between the two groups in gender, age, body mass index, smoking index and severity of airway limitation.②There was no statistically significant difference in the other indexes between the two groups except the percentage of the estimated value of carbon monoxide diffusing capacity (P<0.05) and the percentage of the estimated value of carbon monoxide diffusing capacity/alveolar volume (P<0.05). ③There was no statistically significant difference in CAT scores between the family history group and no family history group.④In no family history group, forced expiratory volume in the first second%pred (FEV1%pred) and forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) were not related to COPD assessment test scores.There was a weak and positive correlation between FEV1%pred, FEV1/FVC and CAT scores in family history group. Conclusions There was no relationship between the familial aggregation of COPD and the lung function and CAT scores.The correlation between lung function and CAT scores is weak. Key words: Chronic obstructive pulmonary disease; Familial aggregation; Lung function; COPD Assessment Test scores

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is currently the fourth leading cause of death in the world. COPD is a growing global health concern affecting over 300 million people worldwide and contributing to ~3 million deaths every year. COPD being a respiratory disorder affects the daily routine activities of people and causes immobilization and makes them bedridden due to dyspnea causing activity limitation. This study aimed to assess this activity-related dyspnea in COPD. MATERIALS AND METHODS: This cross-sectional study was conducted among COPD patients. Patients were assessed based on a detailed history, thorough clinical examination, chest X-ray, sputum for Ziehl–Neelsen staining, and electrocardiogram to fulfill the inclusion and exclusion criteria. Furthermore, spirometry, Modified Medical Research Council (mMRC) Dyspnea scale, COPD assessment test (CAT) score, and Borg’s scale were used to assess the activity-related dyspnea grading. RESULTS: Among 110 participants, the mean age was 57.51 ± 10.86 years with equal gender distribution. The majority of participants (33.6%) showed mMRC grade II dyspnea and medium range CAT category and obstructive pattern on spirometry (92.7%). Hence, there was a linear correlation between the CAT score and the mMRC dyspnea score. CONCLUSION: Based on our findings, we can conclude that these patients’ activities of daily living should be examined, and patients should be directed by a complete multidisciplinary team to offer them better advice to prevent, diagnose, and early treatment of dyspnea.

The COPD Assessment Test (CAT) is a recently introduced, simple-to-use health status instrument that takes less time to complete than better-established health status instruments. In chronic obstructive pulmonary disease (COPD) patients, the CAT improves with pulmonary rehabilitation (PR), and changes correlate with improvements in longer-established health status instruments such as the Chronic Respiratory Questionnaire (CRQ). Increasing numbers of non-COPD patients are referred for PR, but it is not known whether the CAT is responsive to PR in these populations. The CAT score was prospectively measured in 365 consecutive patients (255 COPD, 110 non-COPD) before and after an 8-week PR programme. Pre to post change in CAT was calculated for COPD and non-COPD patients, and correlated with change in the CRQ. For both non-COPD and COPD patients, there was a similar and significant improvement in the mean (95% confidence interval) CAT score following PR (non-COPD: -2.1 (-1.0, -3.2) vs COPD: -3.0 (-2.2, -3.8); P = 0.19). Change in CAT was significantly correlated with all domains of the CRQ in non-COPD patients (all P < 0.01). As in COPD patients, the CAT is immediately responsive to PR in non-COPD patients. Even in unselected chronic respiratory disease patients undergoing PR, the CAT is a practical alternative to longer-established health status questionnaires.