Utility of the CAT in the therapy assessment of COPD exacerbations in China

Abstract

Background: Chronic obstructive pulmonary disease (COPD) exacerbations are accompanied with increased systemic inflammation, which accelerate the pulmonary function injury and impair the quality of life. Prompt and effective treatments for COPD exacerbations slow down the disease progression, but an objective instrument to assess the efficacy of the treatments following COPD exacerbations is lacking nowadays. The COPD Assessment Test (CAT) is an 8-item questionnaire designed to assess and quantify health status and symptom burden in COPD patients. We hypothesize that the change in CAT score is related to the treatment response following COPD exacerbations. Methods: 78 inpatients with clinician-diagnosed acute exacerbation of COPD (AECOPD) completed the CAT, St George's Respiratory Questionnaire (SGRQ) and modified Medical Research Council (mMRC) Dyspnea Scale both at exacerbation and the 7th day of therapy, and a subgroup of 39 patients performed the pulmonary function test. Concentrations of serum C-reactive protein (CRP) and plasma fibrinogen were assayed at the same time. Correlations between the CAT and other measurements were examined. Results: After 7 days' therapy, the CAT and SGRQ scores, mMRC grades, as well as the concentrations of CRP and fibrinogen all decreased significantly (P < 0.001). Meanwhile, the FEV1% predicted had a significant improvement (P < 0.001). The CAT scores were significantly correlated with concurrent concentrations of CRP and fibrinogen, SGRQ scores, FEV1% predicted and mMRC grades (P < 0.05). The change in CAT score was positively correlated with the change of CRP (r = 0.286, P < 0.05), SGRQ score (r = 0.725, P < 0.001) and mMRC grades (r = 0.593, P < 0.001), but not with fibrinogen (r = 0.137, P > 0.05) or FEV1% predicted (r = −0.101, P > 0.05). No relationship was found between the changes of SGRQ score and CRP and fibrinogen (P>0.05).

COPD assessment test score and serum C-reactive protein level in stable COPD patients

“…Systemic inflammation is measured by plasma fibrinogen and serum CRP, which are increased in COPD and aggravated during exacerbations 11. Accordingly, several studies demonstrated that CRP is elevated corresponding to increased CAT score during exacerbations 6,13. In stable COPD, our study showed that CAT score is also independently associated with elevated serum CRP levels even after adjusting for confounding factors, although this statistical relationship is weak.…”

“…Previous studies showed that this instrument provides reliable scores for predicting COPD exacerbation and severity, suggesting the CAT as a potential tool for the stratification of patients who are at risk for exacerbations 6,13,14. Systemic inflammation is measured by plasma fibrinogen and serum CRP, which are increased in COPD and aggravated during exacerbations 11.…”

“…Moreover, an elevated CAT score at exacerbation reflects exacerbation severity 6. Regarding the relationship between CAT score and CRP, change in CAT score from baseline to exacerbation onset was positively correlated to change in serum CRP 6,13. However, the relationship between the CAT score and the serum CRP levels has not been adequately investigated in stable COPD patients.…”

Approaches to drug therapy for COPD in Russia: a proposed therapeutic algorithm

“…This proposed parameter is significantly increased in patients during the progression of an exacerbation, as well as in patients with frequent exacerbations 22,38. The CAT scores, even during exacerbation, are increased in patients with a history of frequent exacerbations 39. Therefore, if the patient does not have increased symptoms (CAT score <10) and FEV 1 ≥50% of normal, prescription of one of the long-acting bronchodilators (LAMA or LABA) is recommended.…”

The COPD assessment test correlates well with&nbsp;the computed tomography measurements in&nbsp;COPD patients in China

“…The CAT has good internal consistency and test–retest reliability;1 previous studies have shown its significance in diagnosis, response to therapies, and management both in stable and exacerbating COPD patients 4–8. CAT scores correlate well with important parameters of the disease, such as dyspnea grades, pulmonary function parameters, etc 7–9. Nowadays, it is widely used in clinical practice all over the world.…”