Exacerbation severity in patients with chronic obstructive pulmonary disease (COPD) can be reliably assessed with a new test.

Developed by researchers at University College London (UCL; United Kingdom), the COPD Assessment Test (CAT) is a validated health status questionnaire that includes questions assessing cough, phlegm, chest tightness, breathlessness, activity limitations, sleep, and energy levels. The researchers conducted a study involved 161 COPD patients who completed the eight-item CAT questionnaire at least once under supervision at the clinic. The CAT questionnaire was also completed by a further 75 patients during 152 treated COPD exacerbations. Patients were also evaluated for changes in C-reactive protein (CRP), fibrinogen, and forced expiratory volume in one second (FEV1) levels.

The results showed that frequent exacerbators (defined as two or more exacerbations per year) had significantly higher baseline CAT scores than infrequent exacerbators. Additionally, CAT scores during the 152 exacerbations rose significantly from an average baseline value of 19.4 to a value of 24.1. The changes in CAT score from baseline to exacerbation onset were significantly associated with falls in FEV1, and weakly but significantly related to change in CRP, but were not related to change in fibrinogen. Median recovery time was significantly related to the time needed for CAT scores to return to baseline. The study was published on January 26, 2012, in the American Journal of Respiratory and Critical Care Medicine.

“The CAT is validated, free, and easy to administer, and can be easily incorporated into the usual care of patients with COPD at no additional cost,” said lead author Alex Mackay, MD, of the UCL academic unit of respiratory medicine. “It may also be useful in clinical trials as an objective measure of new interventions aimed at reducing exacerbation severity. Since our results indicate that CAT scores may reflect levels of systemic inflammatory markers, albeit weakly, this finding may have particular relevance in clinical trials of anti-inflammatory therapeutic agents in COPD.”

COPD is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly coexisting diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs, causing shortness of breath. In clinical practice, COPD is defined by its characteristically low airflow on lung function tests. In contrast to asthma, this limitation is poorly reversible and usually gets progressively worse over time. Worldwide, COPD is projected to be the fourth leading cause of death by 2030, due to an increase in smoking and demographic changes in many countries.

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