Comparison of COPD Assessment Test and Clinical COPD Questionnaire to predict the risk of exacerbation

Yong Suk Jo, Ho Il Yoon, Deog Kyeom Kim, Chul-Gyu Yoo, Chang-Hoon Lee, Yong Suk Jo, Ho Il Yoon, Deog Kyeom Kim, Chul-Gyu Yoo, Chang-Hoon Lee

Abstract

Background and objective: Guidelines recommend the use of simple but comprehensive tools such as COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ) to assess health status in COPD patients. We aimed to compare the ability of CAT and CCQ to predict exacerbation in COPD patients.

Methods: We organized a multicenter prospective cohort study that included COPD patients. The relationships between CAT, CCQ, and other clinical measurements were analyzed by correlation analysis, and the impact of CAT and CCQ scores on exacerbation was analyzed by logistic regression analyses and receiver operating characteristic curve.

Results: Among 121 COPD patients, CAT and CCQ score correlated with other symptom measures, lung function and exercise capacity as well. Compared with patients who did not experience exacerbation, those who experienced exacerbation (n=45; 38.2%) exhibited more severe airflow limitation, were more likely to have a history of exacerbation in the year prior to enrollment, and demonstrated higher CAT scores. CCQ scores were not significantly associated with exacerbations. A CAT score of ≥15 was an independent risk factor for exacerbation (adjusted odds ratio [aOR], 2.40; 95% CI, 1.03-6.50; P=0.04). Furthermore, CAT scores of ≥15 demonstrated an increased predictive ability for exacerbation compared with currently accepted guidelines for the use of CAT (≥10) and CCQ (≥1) in the assessment of COPD patients (area under the curve for CAT ≥15, CAT ≥10, and CCQ ≥1 was 0.61±0.04, 0.53±0.03, and 0.50±0.03, respectively; P=0.03).

Conclusion: A CAT score of ≥15 indicates increased risk of exacerbation in COPD patients, whereas there is no evidence for increased risk based on CCQ score.

Keywords: COPD; exacerbation; questionnaire.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of the included study participants. Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.
Figure 2
Figure 2
Correlation of CAT and CCQ scores with SGRQ (A and D), FEV1% predicted (B and E), and 6MWD (C and F). Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; FEV1, forced expiratory volume in 1 second; 6MWD, 6-minute walk distance; SGRQ, St George’s Respiratory Questionnaire.
Figure 3
Figure 3
The receiver operating characteristic curve to compare the prediction of exacerbation according to the different cutoff levels of symptom assessment tools. Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire.

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