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Observational Study
. 2023 Apr 8;24(1):106.
doi: 10.1186/s12931-023-02394-6.

Chronic Airways Assessment Test: psychometric properties in patients with asthma and/or COPD

Erin L Tomaszewski  1 , Mark J Atkinson  2 , Christer Janson  3 , Niklas Karlsson  4 , Barry Make  5 , David Price  6   7 , Helen K Reddel  8 , Claus F Vogelmeier  9 , Hana Müllerová  10 , Paul W Jones  11 ; NOVELTY Scientific Community; NOVELTY study investigators
Collaborators, Affiliations
Observational Study

Chronic Airways Assessment Test: psychometric properties in patients with asthma and/or COPD

Erin L Tomaszewski et al. Respir Res. .

Abstract

Background: No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT).

Methods: The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD.

Results: CAAT items were internally consistent (Cronbach's alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson's correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4-0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures.

Conclusions: CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice.

Trial registration: NCT02760329.

Keywords: Asthma; COPD; COPD Assessment Test; Chronic Airways Assessment Test; Patient-reported; Psychometrics.

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Conflict of interest statement

ELT, NK and HM are employees of AstraZeneca. MJA reports payment as an independent consultant to Evidera Inc. for activities contracted by AstraZeneca in relation to the psychometric evaluation of the CAAT; he has provided analytic direction and unbiased interpretation of the CAAT findings. CJ reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Teva Pharmaceuticals. PWJ is an employee of GlaxoSmithKline and owns GlaxoSmithKline stocks and shares. BM reports grants (with funds provided to, and controlled by, National Jewish Health) from AstraZeneca, GlaxoSmithKline, NIH National Heart, Lung, and Blood Institute, Pearl Research and Sunovion; personal fees from Takeda and Third Pole; non-financial support from AstraZeneca, Circassia, GlaxoSmithKline, Phillips, Shire, Spiration, Sunovion and Third Pole; and other from Academy Continued Health Care Learning, American College of Chest Physicians, AstraZeneca, Boehringer Ingelheim, Catamount Medical, Circassia, Eastern Pulmonary Society, Eastern VA Medical Center, GlaxoSmithKline, Hybrid Communications, Medscape, Mount Sinai Medical Center, National Jewish Health, Novartis, Phillips, Projects in Knowledge, Science 24/7, Shire, Sunovion, Theravance, Ultimate Medical Academy, Verona, WebMD and Wolters Kluwer Health. DP reports funding for the conduct of this study from AstraZeneca, and discloses board membership with Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mundipharma, Mylan, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme, Teva Pharmaceuticals and Thermo Fisher Scientific; consultancy fees from Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Mylan, Novartis, Pfizer, Teva Pharmaceuticals and Theravance; grants and unrestricted funding for investigator-initiated studies (conducted through Observational and Pragmatic Research Institute Pte Ltd) from AstraZeneca, Boehringer Ingelheim, Chiesi, Circassia, Mundipharma, Mylan, Novartis, Pfizer, Regeneron Pharmaceuticals, Respiratory Effectiveness Group, Sanofi Genzyme, Teva Pharmaceuticals, Theravance and the UK National Health Service; lecture/speaking engagement fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Mundipharma, Mylan, Novartis, Regeneron Pharmaceuticals, Sanofi Genzyme and Teva Pharmaceuticals; payment for the development of educational materials from Mundipharma and Novartis; travel/accommodation/meeting expenses from AstraZeneca, Boehringer Ingelheim, Mundipharma, Mylan, Novartis and Thermo Fisher Scientific; funding for patient enrolment or completion of research from Novartis; stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); 5% shareholding in Timestamp, which develops adherence monitoring technology; is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme and Health Technology Assessment; and was an expert witness for GlaxoSmithKline. HKR has participated in advisory boards for AstraZeneca, Chiesi, GlaxoSmithKline, Novartis and Sanofi Genzyme; and has received honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Sanofi and Teva Pharmaceuticals for independent medical educational presentations; consulting for Novartis and AstraZeneca; and independent research funding from AstraZeneca, GlaxoSmithKline and Novartis. She is Chair of the Global Institute for Asthma Science Committee and a member of the Australian National Asthma Council Guidelines Committee. CFV has given presentations at symposia and/or served on scientific advisory boards sponsored by AstraZeneca, Boehringer Ingelheim, Chiesi, CSL Behring, GlaxoSmithKline, Grifols, MedUpdate, Menarini, Novartis and Nuvaira.

Figures

Fig. 1
Fig. 1
Mean boundary threshold difference between asthma and COPD for CAAT items by effect size units. Each CAAT item was scored between 0 and 5. Effect size units were calculated using Cohen’s d. A negative value indicates a lower response in patients with asthma. The overall mean was calculated as the standardised mean difference from a meta-analysis using a random effects model. Error bars represent 95% confidence intervals. CAAT Chronic Airways Assessment Test, COPD chronic obstructive pulmonary disease
Fig. 2
Fig. 2
Linearity between CAAT and SGRQ total scores for the total sample and each diagnostic group. Error bars represent standard errors; data points with no error bars are representative of one patient with that SGRQ score. CAAT Chronic Airways Assessment Test, COPD chronic obstructive pulmonary disease, SGRQ St George’s Respiratory Questionnaire
Fig. 3
Fig. 3
Bland–Altman plots of CAAT and CAT total scores in asthma + COPD, COPD, and both. Each small circle represents one patient, with the difference between CAAT and CAT total scores (CAT score – CAAT score) plotted against the average of the two scores. Jittering has been added to panel A for clarity where there were multiple superimposed circles. The central line shows the mean difference between the two measures, while the upper and lower lines show the limits of agreement (± 1.96 SD). Data for six patients who did not meet inclusion criteria have been excluded. CAAT Chronic Airways Assessment Test, CAT COPD Assessment Test, COPD chronic obstructive pulmonary disease, N total number of patients in the sample, SD standard deviation
See this image and copyright information in PMC

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