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Original Research |

The COPD Assessment Test: can it discriminate across COPD subpopulations?

N. Gupta, MSc; L. Pinto, MD; A. Benedetti, PhD; P.Z. Li, MSc; W. Tan, MD; S. Aaron, MD; K.R. Chapman, MD; J.M. FitzGerald, MD; P. Hernandez, MD; D. Marciniuk, MD; F. Maltais, MD; D. O'Donnell, MD; D. Sin, MD; B. Walker, MD; J. Bourbeau, MD
Author and Funding Information

Summary conflict of interest statements: Nisha Gupta, has no conflict of interest. Dr. Pinto, has no conflict of interest. Andrea Benedetti has no conflict of interest. Pei Zhi Li, has no conflict of interest. Dr. Tan reports grants from Canadian Institute of Heath Research (CIHR/Rx&D Collaborative Research Program Operating Grants- 93326) with industry partners Astra Zeneca Canada Ltd., Boehringer-Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Merck, Novartis Pharma Canada Inc., Nycomed Canada Inc., Pfizer Canada Ltd., during the conduct of the study. Shawn Aaron, has no conflict of interest. In the past three years, Kenneth R Chapman has received compensation for consulting with AstraZeneca, Baxter, Boehringer-Ingelheim, CSL Behring, GlaxoSmithKline, Grifols, Kamada, Novartis, Nycomed, Roche, and Telacris; has undertaken research funded by Amgen, AstraZeneca, Baxter, Boehringer-Ingelheim, CSL Behring, Forest Labs, GlaxoSmithKline, Grifols, Novartis, Roche and Takeda; and has participated in continuing medical education activities sponsored in whole or in part by AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Grifols, Merck Frosst, Novartis, Pfizer and Takeda. He is participating in research funded by the Canadian Institutes of Health Research operating grant entitled: Canadian Cohort Obstructive Lung Disease (CanCOLD). Professor Chapman holds the GSK-CIHR Research Chair in Respiratory Health Care Delivery at the University Health Network, Toronto, Canada. Dr FitzGerald, has no conflict of interest. Dr. Hernandez (three year period to the subject of the manuscript.) Speaker bureau activities: AstraZeneca; Grifols; Novartis. Industry advisory committees: Almirall; AstraZeneca; Boehringer Ingelheim; GlaxoSmithKline; Grifols; Merck; Novartis. Dr. Marciniuk has undertaken Consultancy with AstraZeneca, Boehringer-Ingelheim, Canadian Foundation for Healthcare Improvement, GlaxoSmithKline, Health Canada, Lung Association of Saskatchewan, Saskatoon Health Region, and the Saskatchewan Ministry of Health. He has received Research Funding (held and managed by the University of Saskatchewan) from AstraZeneca, Boehringer-Ingelheim, Canada Health Infoway, Canadian Institute of Health Research, GlaxoSmithKline, Novartis, Saskatchewan Health Research Foundation, and Schering-Plough. He holds fiduciary positions with the Lung Health Institute of Canada and the University of Saskatchewan Confucius Institute. He is an employee of the University of Saskatchewan. Dr Maltais reports grants and personal fees from Boehringer Ingelheim, grants and personal fees from GlaxoSmithKline, grants from Nycomed, grants and personal fees from Novartis, outside the submitted work. All fees are pooled with other revenues of the group of pulmonologists to which FM is a member and then shared among members of the group. FM holds a CIHR/GSK research Chair on COPD at Université Laval. Dr. O’Donnell, MD serves as a consultant to Boehringer Ingelheim, GlaxoSmithKline, Novartis and Astra Zeneca and serves on the advisory boards of Boehringer Ingelheim, GlaxoSmithKline and Astra Zeneca. He has also participated in talks for Boehringer Ingelheim, Novartis and Astra Zeneca and has received research grant support from Boehringer-Ingelheim, GlaxoSmithKline, Astra Zeneca and Novartis. He has received monetary assistance from Novartis to attend international meetings. Dr Sin has no conflict of interest. Dr Walker conflicts of interest are speaker’s bureau compensation and Advisory board work for both AstraZeneca and Novartis, as well as travel sponsorship from AstraZeneca. Dr. Bourbeau has conflict of interest related to research grants all administered by Research Institute of the MUHC for FRQS, CIHR, RI MUHC and the pharma industry consortium with Almirall, AZ, BI, GSK and Novartis

Funding information: The Canadian Cohort Obstructive Lung Disease (CanCOLD) study is currently funded by the Canadian Respiratory Research Network (CRRN); industry partners: Astra Zeneca Canada Ltd; Boehringer Ingelheim Canada Ltd; GlaxoSmithKline Canada Ltd; Novartis. Researchers at RI-MUHC Montreal and Icapture Centre Vancouver lead the project. Previous funding partners are the CIHR (CIHR/ Rx&D Collaborative Research Program Operating Grants- 93326); the Respiratory Health Network of the FRSQ; industry partners: Almirall; Merck Nycomed; Pfizer Canada Ltd; and Theratechnologies. The funders had no role in the study design, data collection and analysis, or preparation of the manuscript.

This is a prospective study that enrolled patients. Trial registration number: NCT00920348 (ClinicalTrials.gov). Study ID number: IRO-93326.

1Respiratory Epidemiology and Clinical Research Unit, Research Institute of McGill University Health Centre and McGill University, Montreal, Quebec

2University of British Columbia, Vancouver, British Columbia

3Ottawa University, Ottawa, Ontario

4University of Toronto, Toronto, Ontario

5Dalhousie University, Halifax, Nova Scotia

6University of Saskatchewan, Saskatoon, Saskatchewan

7Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec

8Queens University, Kingston, Ontario

9University of Calgary, Calgary, Alberta

Corresponding Author: Jean Bourbeau, M.D., M.Sc., FRCPC, Center for Innovative Medicine, McGill University Health Centre, 1001 Decarie Blvd., Room C047371.5, Montreal, QC, Canada H4A 3J1.


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.06.016
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Abstract

Background  The COPD Assessment Test (CAT) is a valid disease specific questionnaire measuring health status. However, knowledge concerning its use regarding patient and disease characteristics remains limited. Our main objective was to assess the degree to which the CAT score varies and can discriminate between specific patient population groups.

Methods  The Canadian Cohort Obstructive Lung Disease (CanCOLD) is a random-sampled population-based, multicenter prospective cohort that includes subjects with COPD: GOLD 1 to 3. The CAT questionnaire was administered at three visits (baseline, 1.5 and 3 years). The CAT total score was determined for sex, age groups, smoking status, GOLD classification, exacerbations and comorbidities.

Results  716 subjects with COPD were included in the analysis. The majority of subjects (72.5%) were not previously diagnosed with COPD. The mean FEV1/FVC ratio was 61.1 ± 8.1% with a mean FEV1 % predicted of 82.3 ± 19.3%. The mean CAT scores were 5.8 ± 5.0, 9.6 ± 6.7 and 16.1 ± 10.0 for GOLD 1, 2, and 3 and higher, respectively. Higher CAT scores were observed in women, current smokers, ever-smokers and in subjects with previous diagnosis of COPD. The CAT was also able to distinguish between subjects who experience exacerbations versus no-exacerbations.

Conclusions  These results suggest that the CAT, originally designed for use in clinically symptomatic COPD patients, can also be used in individuals with mild airflow obstruction and newly diagnosed COPD. In addition, the CAT was able to discriminate between genders and subjects who experience frequent and infrequent exacerbations.


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