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Original Research |

Tests of the Responsiveness of the COPD Assessment Test Following Acute Exacerbation and Pulmonary RehabilitationCOPD Assessment Test Responsiveness

Paul W. Jones, PhD; Gale Harding, MA; Ingela Wiklund, PhD; Pamela Berry, MSc; Maggie Tabberer, MSc; Ren Yu, MA; Nancy K. Leidy, PhD
Author and Funding Information

From the Division of Clinical Science (Dr Jones), St. George’s University of London, London, England; the Center for Health Outcomes Research (Mss Harding and Yu and Dr Leidy), United Biosource Corporation, Bethesda, MD; the Center for Health Outcomes Research (Dr Wiklund), United BioSource Corporation, London, England; and Global Health Outcomes (Mss Berry and Tabberer), GlaxoSmithKline, London, England.

Correspondence to: Paul W. Jones, PhD, Division of Clinical Science, St. George’s University of London, Cranmer Terr, London, SW17 0RE, England; e-mail: pjones@sgul.ac.uk

Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Jones has received consulting fees and speakers honoraria from GlaxoSmithKline. He was not paid for writing the manuscript. Mss Harding and Yu and Drs Wiklund and Leidy are employed by United BioSource Corporation. United BioSource Corporation provides consulting and other research services to pharmaceutical, device, government, and nongovernment organizations. In this salaried position, they work with a variety of companies and organizations. They received no payment or honoraria directly from these organizations for services rendered and are expressly prohibited from engaging in any independent work of this nature Ms Berry has been directly employed or provided consultancy services to the pharmaceutical industry for 15 years and is currently and employee of GlaxoSmithKline. Ms Tabberer has been directly employed or provided consultancy services to the pharmaceutical industry for 10 years and is currently and employee of GlaxoSmithKline.

Role of sponsors: GlaxoSmithKline did not place any restrictions on this study with respect to the decision of the authors to submit this manuscript for publication.

Funding/Support: This study was supported by GlaxoSmithKline.


Funding/Support: This study was supported by GlaxoSmithKline.

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


Chest. 2012;142(1):134-140. doi:10.1378/chest.11-0309
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Background:  The COPD Assessment Test (CAT) is an eight-item questionnaire suitable for routine clinical use that shows reliability and validity in stable and exacerbating COPD.

Methods:  Study 1 assessed CAT responsiveness to changes in health status in 67 patients during an exacerbation (days 1-14). Study 2 assessed CAT responsiveness in 64 patients undergoing pulmonary rehabilitation (days 1-42). Correlations between CAT and other outcome measures were examined.

Results:  In study 1, mean 14-day improvement in CAT score was −1.4 ± 5.3 units (P = .03). In patients judged to be responders (clinician defined) change in score was −2.6 ± 4.4; in nonresponders it was −0.2 ± 5.9. In study 2, the mean improvement in CAT score was −2.2 ± 5.3 (P = .002); the effect size for the change was −0.33. Effect size for changes in the Chronic Respiratory Questionnaire—Self Administered Standardized (CRQ-SAS) form domain scores ranged from −0.02 to 0.34. Change in 6-min walk distance (6MWD) was 41 ± 55 m. CAT and CRQ-SAS domain scores correlated at baseline (r = −0.54 to −0.69, P < .0001) and in terms of change following pulmonary rehabilitation (r = −0.39 to −0.63, P < .01). Correlations were less strong between change in the CAT and St. George Respiratory Questionnaire for COPD in study 1 (r < 0.24) and for 6MWD (r < 0.11) in study 2.

Conclusions:  These studies indicate that the CAT is sensitive to changes in health status following exacerbations and is as responsive to pulmonary rehabilitation as more complex COPD health status measures.

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