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

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 aft er 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. R ESULTS: 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. © 2014 AMERICAN COLLEGE OF CHEST PHYSICIANS.The authors have reported to CHEST the follow ing conflicts of interest: Dr de Torres received fees for speaking activities for GlaxoSmithKline plc, AstraZeneca, Novartis AG, Merck Sharp & Dohme Corp, and Takeda Pharmaceuticals International GmbH and received consultancy fees for participating on advisory boards for Takeda Pharmaceuticals International GmbH and Novartis AG between 2010 and 2013. Dr Martinez-Gonzalez received fees for speaking activities for Almirall, SA; AstraZeneca; Boehringer Ingelheim GmbH; Pfi zer Inc; GlaxoSmithKline plc; and Chiesi Farmaceutici SpA between 2010 and 2013. Dr de Lucas-Ramos received fees for speaking activities for Almirall, SA; Boehringer Ingelheim GmbH; Takeda Pharmaceuticals International GmbH; and GlaxoSmithKline plc and received grants from Almirall, SA, and Foundation Vital Aire between 2010 and 2013. Dr Cosio received fees for speaking activities for Almirall, SA; Takeda Pharmaceuticals International GmbH; The Menarini Group; Boehringer Ingelheim GmbH; Pfizer Inc; GlaxoSmithKline plc; and Chiesi Farmaceutici SpA between 2010 and 2013. Dr Peces-Barba received fees for speaking activities for Almirall, SA; Takeda Pharmaceuticals International GmbH; Novartis AG; Boehringer Ingelheim GmbH; AstraZeneca; Esteve; GlaxoSmithKline plc, and Chiesi Farmaceutici SpA; received consultancy fees for participating in advisory boards of Takeda Pharmaceuticals International GmbH, Novartis AG, and Ferrer Internacional; and received grants from GlaxoSmithKline plc between 2010 and 2013. Dr Solanes-García received fees for speaking activities for Esteve; AstraZeneca; Th e Menarini Group; Boehringer Ingelheim GmbH; Pfizer Inc; GlaxoSmithKline plc, Biodatos Investigación SL, and Chiesi Farmaceutici SpA between 2010 and 2013. Dr Agüero Balbin received fees for speaking activities for Almirall, SA; AstraZeneca; Novartis AG; Boehringer Ingelheim GmbH; Takeda Pharmaceuticals International GmbH; GlaxoSmithKline plc; and Chiesi Farmaceutici SpA between 2010 and 2013. Dr de Diego-Damia received fees for speaking activities for Boehringer Ingelheim GmbH, AstraZeneca, Pfizer Inc, Merck Sharp & Dohme Corp, GlaxoSmithKline plc, and Chiesi Farmaceutici SpA between 2010 and 2013. Dr Alfageme Michavila received fees for speaking activities for Almirall, SA; Boehringer Ingelheim GmbH; and Pfizer Inc between 2010 and 2013. Dr Irigaray received fees for speaking activities for Novartis AG, Takeda Pharmaceuticals International GmbH, GlaxoSmithKline plc, and Chiesi Farmaceutici SpA between 2010 and 2013. Dr Llunell Casanovas received fees for speaking activities for AstraZeneca, Eli Lilly and Co, and Chiesi Farmaceutici SpA between 2010 and 2013. Dr Galdiz Iturri received fees for speaking activities for Almirall, SA; Novartis AG; AstraZeneca; Boehringer Ingelheim GmbH; GlaxoSmithKline plc; and Chiesi Farmaceutici SpA between 2010 and 2013. Dr Soler-Cataluña participated in speaking activities, on an industry advisory committee, or with other related activities sponsored by Almirall, SA; AstraZeneca; Boehringer Ingelheim GmbH; Pfizer Inc; Ferrer Internacional; GlaxoSmithKline plc; Takeda Pharmaceuticals International GmbH; Merck Sharp & Dohme Corp; Novartis AG; and Grupo Uriach between 2010 and 2013. Dr Soriano received grants from GlaxoSmithKline plc in 2011 and Chiesi Farmaceutici SpA in 2012 through his home institution and participated in speaking activities, on an industry advisory committee, or with other related activities sponsored by Almirall, SA; Boehringer Ingelheim GmbH; Pfizer Inc; Chiesi Farmaceutici SpA; GlaxoSmithKline plc; and Novartis AG between 2010 and 2013. Dr Casanova participated in speaking activities for Almirall, SA; Takeda Pharmaceuticals International GmbH; Chiesi Farmaceutici SpA; GlaxoSmithKline plc; and Novartis AG between 2010 and 2013. Drs Marin, Mir-Viladrich, CalleRubio, Feu-Collado, Balcells, Marín Royo, and Lopez-Campos have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article