The COPD (Chronic Obstructive Pulmonary Disease) Assessment Test: Assessment of Therapeutic Outcomes of Patients at Private Hospitals in Yogyakarta

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...

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.

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

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.

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.

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.

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 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.

Chronic obstructive pulmonary disease (COPD) is associated with multiple comorbidities, including depression, which carries a higher risk of exacerbation and hospitalization in patients with stable COPD. A newly developed questionnaire, the COPD Assessment Test (CAT), was developed as an alternative to other complex, time-consuming tools for quantifying the symptom burden of COPD in routine practice. It is possible that the correlation between the CAT and depression scales could be useful for early evaluation and management of depression in COPD patients. Thus, we investigated the relationship between the CAT and depression as measured by the Patient Health Questionnaires-9 (PHQ-9). We performed a retrospective observational COPD cohort study. A total of 97 patients were enrolled. The Korean versions of the CAT and PHQ-9 were completed for stable patients. A correlation analysis was performed between the PHQ-9 and CAT scores. Significant depression among the groups based on the 2011 GOLD guidelines occurred only in class Gold B and D patients (40% and 60%, respectively). The frequency of depression was significantly higher in the group with higher CAT scores (20~29 versus ≥30; odds ratio: 5.67 versus 22.66). Significant association was observed between the PHQ-9 and CAT scores (r=0.545 and P<0.001). As a result, the PHQ-9 score was significantly higher in COPD patients with a higher CAT score. The CAT is a simple and valuable predictor of depression in COPD patients, and it should be frequently used to detect COPD patients with depression in clinical practice.

Chronic Obstructive Pulmonary Disease (COPD) is a condition that affects over 2 million adults in Poland. In recent years, increasing attention has been focused on improving the quality of life of patients with COPD, which includes alleviating their physical discomfort and relates to their mental health. It is therefore critically important to evaluate research tools that can accurately assess the relationship between the physical and mental health of patients with this disease. This aim of the study is to evaluate the relationship between the COPD Assessment Test (CAT) and the Distress Thermometer and Problem List results in COPD patients. The research evaluated 70 patients with COPD as defined by the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) criteria. Demographic data was obtained at baseline. Disease-specific quality of life was assessed using the CAT score, while overall distress was determined using the Distress Thermometer (DT) scale and a modified Problem List. The relationship between the CAT scores and the results of the Distress Thermometer and Problem List was statistically compared. The study was approved by the Bioethics Committee, and all patients provided written informed consent. The mean ± SD age was 69.6±9.05 (range 47-90) years. The average distress level was 4.09±1.95. A significant relationship was established between the CAT score and the results of the Distress Thermometer Scale (p<0.001); patients with higher CAT scores showed the highest level of distress. CAT was shown to be a simple, fast and clear measurement of disease-specific quality of life and was correlated with levels of distress in patients with COPD. Every patient with COPD should be evaluated using a scale such as the DT to measure their level of psychological distress.

Introduction : COPD Assessment Test (CAT) is an 8-items questionnaire for assessment of health status in patients with chronic obstructive pulmonary disease (COPD).Objective : To evaluate the course of CAT scores during bacterial exacerbations of COPD treated in outpatient setting.Methods : We performed an observational, prospective study including 81 outpatients (57 males and 24 females, aged 43 to 74 years) with bacterial exacerbation of COPD. All participants completed CAT at initial visit (i.e. at the time of diagnosis of exacerbation and beginning of its treatment), 10 and 30 days after initial visit. Mean scores of each item, as well as the overall mean score, at these time points were compared.Results : The mean scores for each CAT question at initial visit varied from 2.6 to 3.5, whereas the mean scores for each CAT question 10 days after initial visit varied from 1.7 to 2.6. We registered significant reduction of the mean overall CAT score 10 days after initial visit as compared to its value at initial visit of 6.9 ± 2.7 points (16.8 vs 23.7; P < 0.001). The mean scores for each CAT question 30 days after initial visit varied from 1.3 to 2.4. We registered reduction of mean overall CAT score 30 days after initial visit as compared to its score 10 days after initial visit of 2.9 ± 1.2 points (13.9 vs 16.8; P < 0.005). The mean overall CAT score 30 days after initial visit was reduced for 9.8 ± 4.5 points as compared to its value at initial visit (13.9 vs 23.7; P < 0.001).Conclusion : We found significant improvement in the patient’s health status during recovery from exacerbation as compared to their health status at the time of exacerbation confirming the CAT as an effective tool to measure health status in patients with COPD.

Chronic obstructive pulmonary disease (COPD) is a progressive disease characterized by airflow limitation that does not fully return to normal and is associated with the increased inflammatory response in the airways due to exposure to noxious particles or gases. Workers are susceptible to exposure to steam, dust, gases, and fumes in the work environment. Administration of antioxidants can be beneficial in COPD patients by reducing oxidative stress to reduce the inflammatory response. Ginger contains various active ingredients that act as antioxidants. The research design is a quasi-experimental study with a pre-test and post-test approach. The research subjects were 30 subjects workers diagnosed with COPD. Subjects were divided into two groups: the control group was given standard therapy, the treatment group was given standard therapy and ginger extract. The treatment was given for one month, then the neutrophil and the COPD Assessment Test (CAT) scores were checked. The data were analyzed with an unpaired difference test. The treatment group (-5.67 +2.32) experienced more CAT decline than the control group (-0.73 +1.28) and showed a significant difference; this was evidenced in the unpaired difference test on the post-pre difference value (p = &lt;0.001). The treatment group (-4.93 +4.43) experienced more neutrophil decline than the control group (0.27 +1.10) and showed a significant difference; this was evidenced in the unpaired difference test on the post-pre difference value (p = &lt; 0.001). Administration of ginger extract can reduce neutrophil levels and CAT scores in COPD workers due to dust exposure. Keywords : COPD, CAT score, neutrophil, gingerCorrespondence : susilobudipratama@gmail.com

Determinants of CAT (COPD Assessment Test) scores in a population of patients with COPD in central and Eastern Europe: The POPE study.

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:The group assignment of chronic obstructive pulmonary disease (COPD) may differ depending on whether the COPD assessment test (CAT) or modified Medical Research Council dyspnoea scale (mMRC) is used.Aims:This study intended to clarify how different patient characteristics influence the differences, to determine the relationships between CAT and mMRC and to characterise COPD patients by both CAT and mMRC.Methods:This was a retrospective, cross-sectional study. The data, collected by Taiwan Obstructive Lung Disease consortium, were managed and analysed.Results:Of the 757 participants, COPD group assignment was not identical as well as no substantial agreement presented when categorised based on the cut-point CAT score ⩾10 and each mMRC cut-point. In all, 38.2% of participants had discordant group assignments together with a lower mean CAT score, less severe airway obstruction and less severe airflow limitation compared with those with concordant group assignments. In the discordant group, the CAT⩾10/mMRC 0–1 subgroup had more wheezing than CAT<10/mMRC⩾2 subgroup. Only moderate correlations existed between CAT and mMRC. More-symptom groups and combined high-risk group had better correlations than less-symptom groups and combined low-risk group, respectively. A modest negative correlation existed between forced expiratory volume in 1 s percentage (FEV1%) predicted and CAT score and between FEV1% predicted and mMRC scale in parallel with a significant positive relationship existing between the CAT score and mMRC scale. Notably, a significant proportion of COPD patients with each scale of mMRC had health status impairment.Conclusions:The Global initiative for Chronic Obstructive Lung Disease committee should redefine the applications of CAT and mMRC in the management of COPD.