Chest
Volume 146, Issue 1, July 2014, Pages 111-122
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Original Research
COPD
Clinical Application of the COPD Assessment Test: Longitudinal Data From the COPD History Assessment in Spain (CHAIN) Cohort

https://doi.org/10.1378/chest.13-2246Get rights and content

OBJECTIVE

The COPD Assessment Test (CAT) has been proposed for assessing health status in COPD, but little is known about its longitudinal changes. The objective of this study was to evaluate 1-year CAT variability in patients with stable COPD and to relate its variations to changes in other disease markers.

METHODS

We evaluated the following variables in smokers with and without COPD at baseline and after 1 year: CAT score, age, sex, smoking status, pack-year history, BMI, modified Medical Research Council (mMRC) scale, 6-min walk distance (6MWD), lung function, BODE (BMI, obstruction, dyspnea, exercise capacity) index, hospital admissions, Hospital and Depression Scale, and the Charlson comorbidity index. In patients with COPD, we explored the association of CAT scores and 1-year changes in the studied parameters.

RESULTS

A total of 824 smokers with COPD and 126 without COPD were evaluated at baseline and 441 smokers with COPD and 66 without COPD 1 year later. At 1 year, CAT scores for patients with COPD were similar (± 4 points) in 56%, higher in 27%, and lower in 17%. Of note, mMRC scale scores were similar (± 1 point) in 46% of patients, worse in 36%, and better in 18% at 1 year. One-year CAT changes were best predicted by changes in mMRC scale scores (β-coefficient, 0.47; P < .001). Similar results were found for CAT and mMRC scale score in smokers without COPD.

CONCLUSIONS

One-year longitudinal data show variability in CAT scores among patients with stable COPD similar to mMRC scale score, which is the best predictor of 1-year CAT changes. Further longitudinal studies should confirm long-term CAT variability and its clinical applicability.

TRIAL REGISTRY

ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.gov

Section snippets

Participants

CHAIN is a Spanish multicenter study carried out in pulmonary clinics and includes active and former smokers with COPD and a control group of patients without COPD. COPD was defined by a history of smoking of at least 10 pack-years and an FEV1/FVC < 0.70 after 400 μg inhaled albuterol. The main goal of this prospective observational study is to perform a multidimensional evaluation of the evolution of patients with COPD to better define the natural history and phenotypes of the disease. The

Results

A total of 824 smokers with COPD and 126 smokers without COPD were evaluated at baseline. Their clinical and physiologic characteristics are provided in Table 1. This mainly middle-aged male population of patients with COPD had a median smoking history of 50 pack-years (one-third still smoked) and represented all degrees of airway obstruction with few comorbidities and hospital admissions. The patients with COPD had mild symptomatic impairment, with a median mMRC scale score of 1; median CAT

Discussion

This 1-year longitudinal observational study of a well-characterized cohort of patients with stable COPD who were maintained on the same treatment demonstrated that changes in CAT scores are associated only with changes in the degree of dyspnea measured by the mMRC scale. The 1-year longitudinal CAT scores of patients with stable COPD exhibited variability similar to that of their mMRC scale scores or the CAT scores in smokers who lacked airway obstruction. The mMRC scale and CAT perform

Acknowledgments

Author contributions: J. P. d. T. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. J. P. d. T., J. M. M., P. d. L.-R., G. P.-B., J. J. S.-C., J. L. L.-C., J. B. S., and C. C. contributed to study concept and design; J. P. d. T., J. M. M., C. M.-G., P. d. L.-R., I. M.-V., B. C., G. P.-B., M. C.-R., I. S.-G., R. A. B., A. d. D.-D, N. F.-C., I. A. M., R. I., E. B., A. L. C., J. B. G. I., M. M. R., J. J.

References (19)

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*A complete list of CHAIN participants in available in e-Appendix 1.

FUNDING/SUPPORT: The PII SEPAR de EPOC endorsed this study. AstraZeneca provided partial funding for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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