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. 2018 Oct 30;16(1):205.
doi: 10.1186/s12955-018-1034-4.

Contribution of individual COPD assessment test (CAT) items to CAT total score and effects of pulmonary rehabilitation on CAT scores

Sarah Houben-Wilke  1 , Daisy J A Janssen  2   3 , Frits M E Franssen  2   4 , Lowie E G W Vanfleteren  2   5 , Emiel F M Wouters  2   4 , Martijn A Spruit  2   6
Affiliations

Contribution of individual COPD assessment test (CAT) items to CAT total score and effects of pulmonary rehabilitation on CAT scores

Sarah Houben-Wilke et al. Health Qual Life Outcomes. .

Abstract

Background: The 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.

Methods: CAT 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.

Results: In 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).

Conclusions: A 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 registration: Netherlands National Trial Register ( NTR3416 ). Registered 2 May 2012.

Keywords: COPD assessment test; GOLD classification; Health status; Pulmonary rehabilitation.

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Conflict of interest statement

Ethics approval and consent to participate

The COPD, health status and co-morbidities (Chance) study was approved by the local ethics committee of Maastricht University Medical Centre+, The Netherlands (MEC11–3-070). All patients gave written informed consent.

Consent for publication

Not applicable.

Competing interests

FMEF discloses consulting and speaker fees from Novartis, GlaxoSmithKline, AstraZeneca, Chiesi, Boehringer Ingelheim and Teva. LEGWV discloses speaker fees from Chiesi, Novartis, GlaxoSmithKline and AstraZeneca. EFMW discloses consulting and speaker fees from Nycomed, Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Novartis and Chiesi. MAS discloses speaker fees from GlaxoSmithKline, Boehringer Ingelheim and AstraZeneca. SH-W and DJAJ have nothing to disclose.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Impact of the four respiratory items (cough, phlegm, chest tightness, breathlessness; formula image) and four non-respiratory items (limited activity, confidence leaving home, sleeplessness, energy;formula image) on the CAT total score a) ≥10 points (n = 469) and b) ≥18 points (n = 373). X-as demonstrates the number of symptomatic (defined as ≥3 points) CAT items. A GOLD 2018 report [1]; B Smid et al. JAMDA 2017 [4]
Fig. 2
Fig. 2
Frequency distributions of CAT item scores before and after PR (n = 381), * p ≤ 0.05
See this image and copyright information in PMC

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