Clinical Role of the Chronic Obstructive Pulmonary Disease Assessment Test in Prediction of the Response to Treatment for Exacerbations

Sunyoung Yoon, Tae Eun Kim, Tae Hyung Kim, Ju Ok Na, Kyeong Cheol Shin, Chin Kook Rhee, Sung Soo Jung, Kang Hyeon Choe, Kwang Ha Yoo, Sunyoung Yoon, Tae Eun Kim, Tae Hyung Kim, Ju Ok Na, Kyeong Cheol Shin, Chin Kook Rhee, Sung Soo Jung, Kang Hyeon Choe, Kwang Ha Yoo

Abstract

Background: The chronic obstructive pulmonary disease (COPD) assessment test (CAT) is a validated, eight-item questionnaire used to quantify the health status of patients. The aim of this study was to evaluate the usefulness of the CAT questionnaire as a tool to assess the response to treatment in acute exacerbations of COPD in an outpatient setting.

Methods: A multicenter, phase 3 randomized controlled trial was conducted previously to examine the efficacy and safety of oral zabofloxacin for the treatment of COPD exacerbations. In the present post hoc analysis of the original study, patients with COPD exacerbation were categorized as responders or non-responders according to the respiratory symptoms persisting on day 10 (visit 3) of treatment. The CAT questionnaire was completed daily by patients at home from the initial visit to the second visit on day 5. Subsequently, the questionnaire was completed in the presence of a physician on days 10 (visit 3) and 36 (visit 4). Multivariate regression analysis was performed to determine the association between CAT scores and the therapeutic response.

Results: The CAT scores decreased more rapidly in responders compared to non-responders during the first 5 days (23.3-20.4 vs. 23.5-22). Among responders, patients with higher severity of illness also revealed higher CAT scores on the first day of an exacerbation (mild, 19.8; moderate, 21.4; severe, 23.8; very severe, 28.6). Multivariate analysis revealed that a change in the CAT score during the first 3 days influenced the therapeutic response. A significant decrease in scores in the domains of sputum production, chest tightness, and activities of daily living was seen among responders.

Conclusion: Early improvement in CAT scores may be associated with a more favorable response to the treatment of COPD exacerbations.

Trial registration: ClinicalTrials.gov Identifier: NCT01658020.

Trial registration: Clinical Research Information Service Identifier: KCT0000532.

Keywords: Chronic Obstructive Pulmonary Disease; Chronic Obstructive Pulmonary Disease Assessment Test; Exacerbation; Questionnaire; Treatment Response.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

© 2020 The Korean Academy of Medical Sciences.

Figures

Fig. 1. Study design and enrollment.
Fig. 1. Study design and enrollment.
Fig. 2. Time course of CAT scores…
Fig. 2. Time course of CAT scores in both groups.
CAT = chronic obstructive pulmonary disease assessment test.
Fig. 3. Change of CAT scores during…
Fig. 3. Change of CAT scores during follow-up.
CAT = chronic obstructive pulmonary disease assessment test.
Fig. 4. Change in the mean CAT…
Fig. 4. Change in the mean CAT score based on the severity of disease. (A) Change in the mean CAT scores among responders. (B) Change in the mean CAT scores among non-responders. Severity of disease was classified according to the GOLD criteria.
CAT = chronic obstructive pulmonary disease assessment test, GOLD = Global Initiative for Chronic Obstructive Lung Disease.

References

    1. Connors AF, Jr, Dawson NV, Thomas C, Harrell FE, Jr, Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (study to understand prognoses and preferences for outcomes and risks of treatments) Am J Respir Crit Care Med. 1996;154(4 Pt 1):959–967.
    1. Seemungal TA, Donaldson GC, Paul EA, Bestall JC, Jeffries DJ, Wedzicha JA. Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(5 Pt 1):1418–1422.
    1. Miravitlles M, García-Polo C, Domenech A, Villegas G, Conget F, de la Roza C. Clinical outcomes and cost analysis of exacerbations in chronic obstructive pulmonary disease. Lung. 2013;191(5):523–530.
    1. Miravitlles M, Murio C, Guerrero T, Gisbert R DAFNE Study Group. Decisiones sobre Antibioticoterapia y Farmacoeconomía en la EPOC. Pharmacoeconomic evaluation of acute exacerbations of chronic bronchitis and COPD. Chest. 2002;121(5):1449–1455.
    1. Reiger G, Zwick R, Lamprecht B, Kähler C, Burghuber OC, Valipour A. Phenotypes of COPD in an Austrian population : national data from the POPE study. Wien Klin Wochenschr. 2018;130(11-12):382–389.
    1. Koblizek V, Milenkovic B, Barczyk A, Tkacova R, Somfay A, Zykov K, et al. Phenotypes of COPD patients with a smoking history in Central and Eastern Europe: the POPE study. Eur Respir J. 2017;49(5):1601446.
    1. Gupta N, Pinto LM, Morogan A, Bourbeau J. The COPD assessment test: a systematic review. Eur Respir J. 2014;44(4):873–884.
    1. Jones PW, Harding G, Wiklund I, Berry P, Tabberer M, Yu R, et al. Tests of the responsiveness of the COPD assessment test following acute exacerbation and pulmonary rehabilitation. Chest. 2012;142(1):134–140.
    1. Dodd JW, Hogg L, Nolan J, Jefford H, Grant A, Lord VM, et al. The COPD assessment test (CAT): response to pulmonary rehabilitation. A multicentre, prospective study. Thorax. 2011;66(5):425–429.
    1. Mackay AJ, Donaldson GC, Patel AR, Jones PW, Hurst JR, Wedzicha JA. Usefulness of the chronic obstructive pulmonary disease assessment test to evaluate severity of COPD exacerbations. Am J Respir Crit Care Med. 2012;185(11):1218–1224.
    1. Pothirat C, Chaiwong W, Limsukon A, Deesomchok A, Liwsrisakun C, Bumroongkit C, et al. Detection of acute deterioration in health status visit among COPD patients by monitoring COPD assessment test score. Int J Chron Obstruct Pulmon Dis. 2015;10:277–282.
    1. Varol Y, Ozacar R, Balci G, Usta L, Taymaz Z. Assessing the effectiveness of the COPD assessment test (CAT) to evaluate COPD severity and exacerbation rates. COPD. 2014;11(2):221–225.
    1. Zhou A, Zhou Z, Peng Y, Zhao Y, Duan J, Chen P. The role of CAT in evaluating the response to treatment of patients with AECOPD. Int J Chron Obstruct Pulmon Dis. 2018;13:2849–2858.
    1. Choi HS, Park YB, Shin KC, Jang SH, Choe KH, Kim YS, et al. Exacerbations of chronic obstructive pulmonary disease tool to assess the efficacy of acute treatment. Int J Chron Obstruct Pulmon Dis. 2019;14:471–478.
    1. Rhee CK, Chang JH, Choi EG, Kim HK, Kwon YS, Kyung SY, et al. Zabofloxacin versus moxifloxacin in patients with COPD exacerbation: a multicenter, double-blind, double-dummy, randomized, controlled, phase III, non-inferiority trial. Int J Chron Obstruct Pulmon Dis. 2015;10:2265–2275.
    1. Vogelmeier CF, Criner GJ, Martinez FJ, Anzueto A, Barnes PJ, Bourbeau J, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD executive summary. Am J Respir Crit Care Med. 2017;195(5):557–582.
    1. Anthonisen NR, Manfreda J, Warren CP, Hershfield ES, Harding GK, Nelson NA. Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 1987;106(2):196–204.
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD assessment test. Eur Respir J. 2009;34(3):648–654.
    1. Kon SS, Canavan JL, Jones SE, Nolan CM, Clark AL, Dickson MJ, et al. Minimum clinically important difference for the COPD assessment test: a prospective analysis. Lancet Respir Med. 2014;2(3):195–203.
    1. Wilkinson TM, Donaldson GC, Hurst JR, Seemungal TA, Wedzicha JA. Early therapy improves outcomes of exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2004;169(12):1298–1303.
    1. Ringbaek T, Martinez G, Lange P. A comparison of the assessment of quality of life with CAT, CCQ, and SGRQ in COPD patients participating in pulmonary rehabilitation. COPD. 2012;9(1):12–15.
    1. Tsukino M, Nishimura K, Ikeda A, Koyama H, Mishima M, Izumi T. Physiologic factors that determine the health-related quality of life in patients with COPD. Chest. 1996;110(4):896–903.
    1. Jones PW, Brusselle G, Dal Negro RW, Ferrer M, Kardos P, Levy ML, et al. Properties of the COPD assessment test in a cross-sectional European study. Eur Respir J. 2011;38(1):29–35.
    1. Feliz-Rodriguez D, Zudaire S, Carpio C, Martínez E, Gómez-Mendieta A, Santiago A, et al. Evolution of the COPD assessment test score during chronic obstructive pulmonary disease exacerbations: determinants and prognostic value. Can Respir J. 2013;20(5):e92–7.
    1. Gulart AA, Munari AB, Queiroz AP, Cani KC, Matte DL, Mayer AF. Does the COPD assessment test reflect functional status in patients with COPD? Chron Respir Dis. 2017;14(1):37–44.
    1. Becker C, Schäfer J, Carvalho LL, Vitiello IP, da Silva AL. CAT correlates positively with respiratory rate and is a significant predictor of the impact of COPD on daily life of patients: a cross sectional study. Multidiscip Respir Med. 2014;9(1):47.
    1. Tsiligianni IG, van der Molen T, Moraitaki D, Lopez I, Kocks JW, Karagiannis K, et al. Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ) BMC Pulm Med. 2012;12(1):20.
    1. Wang Q, Bourbeau J. Outcomes and health-related quality of life following hospitalization for an acute exacerbation of COPD. Respirology. 2005;10(3):334–340.
    1. Bourbeau J, Ford G, Zackon H, Pinsky N, Lee J, Ruberto G. Impact on patients' health status following early identification of a COPD exacerbation. Eur Respir J. 2007;30(5):907–913.

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