The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients

Sang Do Lee; Ming Shyan Huang; Jian Kang; Ching Hsiung Lin; Myung Jae Park; Yeon Mok Oh; Namhee Kwon; Paul W. Jones; Dimitar Sajkov

doi:10.1016/j.rmed.2013.12.014

The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients

Sang Do Lee
, Ming Shyan Huang
, Jian Kang
, Ching Hsiung Lin
, Myung Jae Park
, Yeon Mok Oh
, Namhee Kwon
, Paul W. Jones
, Dimitar Sajkov

Research output: Contribution to journal › Article › peer-review

113 Citations (Scopus)

Abstract

We evaluated the predictive value of the COPD assessment test (CAT™) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0-9, 10-19, 20-29, and 30-40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p = 0.001 or p < 0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p = 0.023) and any exacerbation during the study period (adjusted RR 1.15; p = 0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation. Trial registration Clinicaltrials.gov: NCT01254032.

Original language	English
Pages (from-to)	600-608
Number of pages	9
Journal	Respiratory Medicine
Volume	108
Issue number	4
DOIs	https://doi.org/10.1016/j.rmed.2013.12.014
Publication status	Published - Apr 2014

Bibliographical note

Funding Information:
Sang-Do Lee served as a consultant to GlaxoSmithKline and Nycomed, and has received speakers' honoraria from GlaxoSmithKline, AstraZeneca, Boehringer, Nycomed, Takeda, Abbott, and Norvatis. Yeon-Mok Oh has received funding from GlaxoSmithKline, MSD Korea, AstraZeneca Korea, Boehringer Ingelheim Korea, Handok, Asan Institute for Life Science and University of Ulsan College of Medicine, speakers' honoraria from GlaxoSmithKline, MSD Korea, AstraZeneca Korea, Boehringer Ingelheim Korea, Handok, Pfizer Korea, and Korea Doctors' Weekly, and payment for development of a presentation for Diachi Sankyo Korea. Paul W Jones served as a consultant and speaker for GlaxoSmithKline and has received funding from GlaxoSmithKline. Namhee Kwon is an employee of GlaxoSmithKline and owns stocks in GlaxoSmithKline. The other authors declare they have no competing interests.

Funding Information:
This study was funded by GlaxoSmithKline . We would like to thank all the investigators and patients for their contributions to the study. We acknowledge the statistical support provided by Yiong Huak Chan and the editorial support provided by Hui Hwa Choo of Research2Trials Clinical Solutions Pte Ltd. This support was funded by GlaxoSmithKline.

Keywords

COPD assessment test
Chronic obstructive pulmonary disease
Exacerbation
Prediction

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10.1016/j.rmed.2013.12.014

Cite this

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title = "The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients",

abstract = "We evaluated the predictive value of the COPD assessment test (CAT{\texttrademark}) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0-9, 10-19, 20-29, and 30-40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p = 0.001 or p < 0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p = 0.023) and any exacerbation during the study period (adjusted RR 1.15; p = 0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation. Trial registration Clinicaltrials.gov: NCT01254032.",

keywords = "COPD assessment test, Chronic obstructive pulmonary disease, Exacerbation, Prediction",

author = "Lee, \{Sang Do\} and Huang, \{Ming Shyan\} and Jian Kang and Lin, \{Ching Hsiung\} and Park, \{Myung Jae\} and Oh, \{Yeon Mok\} and Namhee Kwon and Jones, \{Paul W.\} and Dimitar Sajkov",

note = "Funding Information: Sang-Do Lee served as a consultant to GlaxoSmithKline and Nycomed, and has received speakers' honoraria from GlaxoSmithKline, AstraZeneca, Boehringer, Nycomed, Takeda, Abbott, and Norvatis. Yeon-Mok Oh has received funding from GlaxoSmithKline, MSD Korea, AstraZeneca Korea, Boehringer Ingelheim Korea, Handok, Asan Institute for Life Science and University of Ulsan College of Medicine, speakers' honoraria from GlaxoSmithKline, MSD Korea, AstraZeneca Korea, Boehringer Ingelheim Korea, Handok, Pfizer Korea, and Korea Doctors' Weekly, and payment for development of a presentation for Diachi Sankyo Korea. Paul W Jones served as a consultant and speaker for GlaxoSmithKline and has received funding from GlaxoSmithKline. Namhee Kwon is an employee of GlaxoSmithKline and owns stocks in GlaxoSmithKline. The other authors declare they have no competing interests. Funding Information: This study was funded by GlaxoSmithKline . We would like to thank all the investigators and patients for their contributions to the study. We acknowledge the statistical support provided by Yiong Huak Chan and the editorial support provided by Hui Hwa Choo of Research2Trials Clinical Solutions Pte Ltd. This support was funded by GlaxoSmithKline. ",

year = "2014",

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doi = "10.1016/j.rmed.2013.12.014",

language = "English",

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journal = "Respiratory Medicine",

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TY - JOUR

T1 - The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients

AU - Lee, Sang Do

AU - Huang, Ming Shyan

AU - Kang, Jian

AU - Lin, Ching Hsiung

AU - Park, Myung Jae

AU - Oh, Yeon Mok

AU - Kwon, Namhee

AU - Jones, Paul W.

AU - Sajkov, Dimitar

N1 - Funding Information: Sang-Do Lee served as a consultant to GlaxoSmithKline and Nycomed, and has received speakers' honoraria from GlaxoSmithKline, AstraZeneca, Boehringer, Nycomed, Takeda, Abbott, and Norvatis. Yeon-Mok Oh has received funding from GlaxoSmithKline, MSD Korea, AstraZeneca Korea, Boehringer Ingelheim Korea, Handok, Asan Institute for Life Science and University of Ulsan College of Medicine, speakers' honoraria from GlaxoSmithKline, MSD Korea, AstraZeneca Korea, Boehringer Ingelheim Korea, Handok, Pfizer Korea, and Korea Doctors' Weekly, and payment for development of a presentation for Diachi Sankyo Korea. Paul W Jones served as a consultant and speaker for GlaxoSmithKline and has received funding from GlaxoSmithKline. Namhee Kwon is an employee of GlaxoSmithKline and owns stocks in GlaxoSmithKline. The other authors declare they have no competing interests. Funding Information: This study was funded by GlaxoSmithKline . We would like to thank all the investigators and patients for their contributions to the study. We acknowledge the statistical support provided by Yiong Huak Chan and the editorial support provided by Hui Hwa Choo of Research2Trials Clinical Solutions Pte Ltd. This support was funded by GlaxoSmithKline.

PY - 2014/4

Y1 - 2014/4

N2 - We evaluated the predictive value of the COPD assessment test (CAT™) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0-9, 10-19, 20-29, and 30-40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p = 0.001 or p < 0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p = 0.023) and any exacerbation during the study period (adjusted RR 1.15; p = 0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation. Trial registration Clinicaltrials.gov: NCT01254032.

AB - We evaluated the predictive value of the COPD assessment test (CAT™) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0-9, 10-19, 20-29, and 30-40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p = 0.001 or p < 0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p = 0.023) and any exacerbation during the study period (adjusted RR 1.15; p = 0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation. Trial registration Clinicaltrials.gov: NCT01254032.

KW - COPD assessment test

KW - Chronic obstructive pulmonary disease

KW - Exacerbation

KW - Prediction

UR - https://www.scopus.com/pages/publications/84896078225

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DO - 10.1016/j.rmed.2013.12.014

M3 - Article

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AN - SCOPUS:84896078225

SN - 0954-6111

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EP - 608

JO - Respiratory Medicine

JF - Respiratory Medicine

IS - 4

ER -

The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients

Abstract

Bibliographical note

Keywords

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