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Original Research: COPD |

Clinical Application of the COPD Assessment TestClinical Application of the COPD Assessment Test: Longitudinal Data From the COPD History Assessment in Spain (CHAIN) Cohort

Juan P. de Torres, MD; Jose M. Marin, MD; Cristina Martinez-Gonzalez, MD; Pilar de Lucas-Ramos, MD; Isabel Mir-Viladrich, MD; Borja Cosio, MD; German Peces-Barba, MD; Miryam Calle-Rubio, MD; Ingrid Solanes-García, MD; Ramón Agüero Balbin, MD; Alfredo de Diego-Damia, MD; Nuria Feu-Collado, MD; Inmaculada Alfageme Michavila, MD; Rosa Irigaray, MD; Eva Balcells, MD; Antònia Llunell Casanovas, MD; Juan Bautista Galdiz Iturri, MD; Margarita Marín Royo, MD; Juan J. Soler-Cataluña, MD; Jose Luis Lopez-Campos, MD; Joan B. Soriano, MD; Ciro Casanova, MD; for the COPD History Assessment in Spain (CHAIN) Cohort*
Author and Funding Information

From the Pulmonary Department (Dr de Torres), Clínica Universidad de Navarra, Pamplona; Pulmonary Department (Dr Marin), Hospital Universitario Miguel Servet, Zaragoza; Pulmonary Department (Dr Martinez-Gonzalez), Hospital Central de Asturias, Oviedo; Pulmonary Department I (Dr de Lucas-Ramos), Hospital Gregorio Marañon, Madrid; Pulmonary Department (Dr Mir-Viladrich), Hospital Son Llátzer, Palma de Mallorca; Pulmonary Department (Dr Cosio), Hospital Son Espases, Palma de Mallorca; Pulmonary Department (Dr Peces-Barba), Fundación Jimenez Diaz, Madrid; Pulmonary Department (Dr Calle-Rubio), Hospital Clinico San Carlos, Madrid; Pulmonary Department (Dr Solanes-García), Hospital San Pablo y la Santa Cruz, Barcelona; Pulmonary Department (Dr Agüero Balbin), Hospital Marques de Valdecilla, Santander; Pulmonary Department (Dr de Diego-Damia), Hospital Universitario y Politécnico La Fe, Valencia; Pulmonary Department (Dr Feu-Collado), Hospital Universitario Reina Sofía, Cordoba; Pulmonary Department (Dr Alfageme Michavila), Hospital Universitario de Valme, Sevilla; Pulmonary Department (Dr Irigaray), Hospital de Manacor, Mallorca; Pulmonary Department (Dr Balcells), Hospital del Mar, Barcelona; Pulmonary Department (Dr Llunell Casanovas), Hospital de Terrassa, Terrassa; Pulmonary Department (Dr Galdiz Iturri), Hospital de Cruces, UPV/EHU, Bilbao; Pulmonary Department (Dr Marín Royo), Hospital General de Castellón, Castellón; Pulmonary Department (Dr Soler-Cataluña), Hospital General de Requena, Valencia; Unidad Médico-Quirúrgica de Enfermedades Respiratorias (Dr Lopez-Campos), Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Sevilla; Epidemiology and Clinical Research (Dr Soriano), CIMERA, Bunyola, Mallorca; Pulmonary Department (Dr Casanova), Hospital Universitario Nuestra Señora de Candelaria, Tenerife; and CIBER de Enfermedades Respiratorias (CIBERES) (Drs Marin, Cosio, Peces-Barba, Balcells, Galdiz Iturri, Soler-Cataluña, and Lopez-Campos), Instituto de Salud Carlos III, Madrid, Spain.

CORRESPONDENCE TO: Juan P. de Torres, MD, Pulmonary Department, Clinica Universidad de Navarra, Avenida Pío XII, 36, 31800 Pamplona, Spain; e-mail: jupa65@hotmail.com


*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.


Chest. 2014;146(1):111-122. doi:10.1378/chest.13-2246
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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

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