CAT score single item analysis in patients with COPD: Results from COSYCONET

Siemens, Sarah Marietta von; Alter, Peter; Lutter, Johanna I.; Kauczor, Hans‐Ulrich; Jobst, Bertram; Trudzinski, Franziska; Söhler, Sandra; Waschki, Benjamin; Jones, Paul; Vogelmeier, Claus; Jörres, Rudolf A.; Stefan, Andreas; Bals, Robert; Behr, Jürgen; Kahnert, Kathrin; Burkhard, Bewig; Buhl, Roland; Ewert, Ralf; Beate, Stubbe; Ficker, Joachim H.; Manfred, Gogol; Grohé, Christian; Rainer, Hauck; Matthias, Held; Jany, B; Markus, Henke; Gerd, Höffken; Hugo, A. Katus; Kirsten, Anne-Marie; Watz, Henrik; Rembert, Koczulla; Kenn, Klaus; Juliane, Kronsbein; Kropf-Sanchen, Cornelia; Christoph, Lange; Zabel, P.; Pfeifer, Michael; Winfried, J. Randerath; Seeger, Werner; Studnicka, Michael; Taube, Christian; Helmut, Teschler; Timmermann, Hartmut; Christian, Virchow J.; Vogelmeier, C. Franz; Ulrich, Wagner; Welte, Tobias; Hubert, Wirtz; Lehnert, Doris; Struck, Birte; Krabbe, Lenka; Arikan, Barbara; Tobias, Julia; Speth, Kornelia; Pieper, Jeanette; Gleiniger, Margret; Markworth, Britta; Hinz, Zaklina; Burmann, Ellen; Wons, Katrin; Rieber, Ulrike; Schaufler, Beate; Schwedler, K; Michalewski, Sabine; Rohweder, Sonja; Berger, Patricia J.; Schottel, Diana; Janke, Vivien; Untsch, Rosalie; Graf, Jana; Reichel, Anita; Weiss, Gertraud; Traugott, Erich; Kietzmann, I; Schrade-Illmann, Michaela; Polte, Beate; Hübner, Gudrun

doi:10.1016/j.rmed.2019.105810

Cited by 19 publications

(19 citation statements)

References 27 publications

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“…Previous studies have typically used the total CAT score to determine the correlation with patients’ symptoms, clinical course, lung function, and other PROs. 15 – 17 However, a recent study reported that single items of the CAT contain additional information regarding COPD phenotypes, 31 presence of emphysema, 19 comorbidities, 32 and fatigue, 33 which is not discernible from the total score. Another study suggested that the CAT items contribute differently to the total score.…”

Section: Discussionmentioning

confidence: 99%

“… 15 – 17 Recent studies have shown that each CAT item contains additional information and contributes differently to the total score. 18 – 20 However, to the best of our knowledge, there are a few data primarily focusing on changes in each CAT item after bronchodilator therapy initiation and its association with other clinical factors. Thus, we investigated changes in individual CAT scores after short-term bronchodilator therapy among treatment-naïve patients with COPD and compared lung function, mMRC dyspnea, and exacerbations between patients whose CAT scores improved and those whose CAT scores did not.…”

Section: Introductionmentioning

confidence: 99%

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Change in individual chronic obstructive pulmonary disease assessment test item scores after short-term bronchodilator therapy and its impact on exacerbation in treatment-naïve patients with chronic obstructive pulmonary disease

Kim

Shin

Gil

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) measures the health status of patients with COPD. We aimed to investigate the change in individual CAT scores after short-term bronchodilator therapy among treatment-naïve patients with COPD. Methods: Data from 148 patients newly diagnosed with COPD between January 2016 and April 2020 were retrospectively analyzed. We compared the CAT score, modified Medical Research Council (mMRC) dyspnea grade, and forced expiratory volume in 1 s (FEV1) before and after short-term (6 ± 2 months) bronchodilator therapy. We analyzed the change trends using generalized estimating equations. Results: The mean patient age was 70.9 years, and 92.6% were male. The total CAT score did not significantly improve. However, among the CAT items, phlegm [adjusted difference: –0.22 (–0.48, –0.002)], chest tightness [–0.30 (–0.56, –0.05)], and breathlessness [–0.45 (–0.66, –0.23)] scores significantly improved after bronchodilator therapy. The patients were divided into two groups: CAT score improved ( n = 69) and not improved group ( n = 79). The development of moderate-to-severe exacerbations during follow-up was significantly lower (2.9% versus 17.7%, p = 0.004) in the CAT score improved group. Conclusion: The improvement in CAT items indicating respiratory symptoms was more evident than the CAT total score after short-term bronchodilator therapy. Despite the significant increase in FEV1 after bronchodilator therapy, fewer than half of the patients achieved meaningful improvement in CAT, and this group showed significantly lower development of exacerbation during follow-up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Change in individual chronic obstructive pulmonary disease assessment test item scores after short-term bronchodilator therapy and its impact on exacerbation in treatment-naïve patients with chronic obstructive pulmonary disease

Kim

Shin

Gil

et al. 2022

Therapeutic Advances in Chronic Disease

View full text Add to dashboard Cite

show abstract

“…There is some emerging evidence that individual CAT items provide additional information to the CAT total score, such as the ability to predict the presence of undiagnosed COPD or emphysema, however further research is needed in this regard. 90,91 Both the E-RS total-and E-RS sub-scores have demonstrated good internal consistency and test-retest reliability over two consecutive days. 89 Moderate associations between the total score and the breathlessness sub-score, and other measures of HRQoL have also been reported in people with COPD.…”

Section: Assessment Of Severitymentioning

confidence: 98%

How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

Lewthwaite¹,

Jensen²,

Ekström³

2021

COPD

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Activity-related breathlessness is the most problematic symptom of chronic obstructive pulmonary disease (COPD), arising from complex interactions between peripheral pathophysiology (both pulmonary and non-pulmonary) and central perceptual processing. To capture information on the breathlessness experienced by people with COPD, many different instruments exist, which vary in applicability depending on the purpose and context of assessment. We reviewed common breathlessness assessment instruments, providing recommendations around how to assess the severity of, or change in, breathlessness in people with COPD in daily life or in response to exercise provocation. A summary of 14 instruments for the assessment of breathlessness severity in daily life is presented, with 11/14 (79%) instruments having established minimal clinically importance differences (MCIDs) to assess and interpret breathlessness change. Instruments varied in their scope of assessment (functional impact of breathlessness or the severity of breathlessness during different activities, focal periods, or alongside other common COPD symptoms), dimensions of breathlessness assessed (uni-/multidimensional), rating scale properties and intended method of administration (self-administered versus interviewer led). Assessing breathlessness in response to an acute exercise provocation overcomes some limitations of daily life assessment, such as recall bias and lack of standardized exertional stimulus. To assess the severity of breathlessness in response to an acute exercise provocation, unidimensional or multidimensional instruments are available. Borg’s 0–10 category rating scale is the most widely used instrument and has estimates for a MCID during exercise. When assessing the severity of breathlessness during exercise, measures should be taken at a standardized submaximal point, whether during laboratory-based tests like cardiopulmonary exercise testing or field-based tests, such as the 3-min constant rate stair stepping or shuttle walking tests. Recommendations are provided around which instruments to use for breathlessness assessment in daily life and in relation to exertion in people with COPD.

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“…13,14 Previous studies on CAT mostly focused on total score, [10][11][12] rather than each item of CAT. A few have investigated single CAT items with regard to COPD screening, 15 phenotypes, 16,17 comorbidities, 18,19 emphysema, 18 and fatigue. 2 However, studies on the distribution and clinical significance of single items in CAT based on CAT total scores are lacking.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of COPD Patients According to COPD Assessment Test (CAT) Score Level: Cross-Sectional Study

Gil¹,

Zo²,

Jones³

et al. 2021

COPD

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Purpose The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is widely used to assess the impact of COPD symptoms on health status. Whilst the CAT consists of eight different items, details on the distribution of each item are limited. This study aimed to investigate the distribution and clinical implication of each CAT item, stratified by CAT severity group, in stable COPD patients. Patients and Methods This was a cross-sectional study at a single referral hospital in South Korea. Spirometry confirmed COPD patients with CAT measured at the first clinical visit were retrospectively identified. Patients were categorized into three groups: low (0 ≤ CAT < 10), medium (10 ≤ CAT < 20), and high (20 ≤ CAT ≤ 40) impact group. For the purpose of this analysis, the first four items (cough, sputum, chest tightness, and dyspnea) and the remaining four items (activities, confidence, sleep and energy) were also grouped as “pulmonary” and “extra-pulmonary”, respectively. Results A total of 815 patients were included, and mean (SD) forced expiratory volume in 1 s (FEV 1 ) was 62.8 (17.4) % pred. Among them, 300 patients (36.8%) were in the high impact group and had a greater exacerbation history and lower lung function. The proportion of “extra-pulmonary” items score was greater in patients with higher total CAT scores, with the activity and confidence items showing higher scores. Conclusion In our study, in addition to dyspnea, activity limitation is a particular problem in individual patients with higher CAT total scores, for which physicians need to pay more attention. Our study suggests that whilst CAT total score captures the overall impact of COPD, each item of the CAT contains potentially useful information in understanding the patient’s symptom burden.

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CAT score single item analysis in patients with COPD: Results from COSYCONET

Cited by 19 publications

References 27 publications

Change in individual chronic obstructive pulmonary disease assessment test item scores after short-term bronchodilator therapy and its impact on exacerbation in treatment-naïve patients with chronic obstructive pulmonary disease

Change in individual chronic obstructive pulmonary disease assessment test item scores after short-term bronchodilator therapy and its impact on exacerbation in treatment-naïve patients with chronic obstructive pulmonary disease

How to Assess Breathlessness in Chronic Obstructive Pulmonary Disease

Clinical Characteristics of COPD Patients According to COPD Assessment Test (CAT) Score Level: Cross-Sectional Study

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