The role of CAT in evaluating the response to treatment of patients with AECOPD

International Journal of COPD Dovepress open access to scientific and medical research Original Research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Open Access Full Text Article The role of CAT in evaluating the response to treatment of patients with AECOPD This article was published in the following Dove Press journal: International Journal of COPD Aiyuan Zhou 1–3 Zijing Zhou 1–3 Yating Peng 1–3 Yiyang Zhao 1–3 Jiaxi Duan 1–3 Ping Chen 1–3 Department of Respiratory Medicine, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; 2Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China; 3Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan 410011, China 1 Introduction Correspondence: Ping Chen Department of Respiratory Medicine, Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China Tel +86 731 8529 5248 Fax +86 731 8529 5848 Email COPD is defined by the GOLD as a disease characterized by airflow limitation, which is not fully reversible; it will represent the fourth leading cause of mortality worldwide by 2020.1 The progress of COPD can always be deteriorated by the incidence of exacerbations. It was proved that exacerbation was an important life-threatening event for patients with COPD.2,3 Patients who suffer frequent and repeated exacerbations within 1 year have a poor prognosis,4 low HRQOL,5 rapid decline in lung function,6–8 and high mortality.9 Effective treatment could improve the quality of life and decrease the economic burden of these patients. However, patients with AECOPD have various phenotypes10 and often present different responses to treatment.11,12 Thus, to make timely and reasonable changes of the therapy for those who have no response to the 2849 submit your manuscript | www.dovepress.com International Journal of COPD 2018:13 2849–2858 Dovepress © 2018 Zhou et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/COPD.S175085 Powered by TCPDF (www.tcpdf.org) Background: The chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) questionnaire is a short patient-completed questionnaire, which is used to assess the health status of patients with stable COPD. However, whether it is a good tool to evaluate the response to treatment in acute exacerbation of COPD (AECOPD) has been less studied. Methods: The patients were assessed at two visits, at admission and on the seventh day. Anthropometric variables were collected at admission. CAT and lung function were measured twice at the above time points. At the second visit, the health status of the patients were divided into five groups based on a 5-point Likert scale, ranging from 1 to 5, which represents “much better,” “slightly better,” “no change,” “slightly worse,” and “much worse.” Responders were those who reported “much better” or “slightly better,” and nonresponders were those who claimed “no change,” “worse,” or “much worse.” Results: In total, 225 patients were recruited. The average CAT score at admission was 24.82±7.41, which declined to 17.41±7.35 on the seventh day. There were 81.33% responders, whose improvement in CAT score (9.37±5.24) was much higher than that of the nonresponders (−1.36±4.35). A moderate correlation was observed between the changes in CAT score and improvement in FEV1, FEV1%, and the length of hospital stay. There was a strong correlation between the changes in CAT score and health status. A 3.5-unit improvement in the CAT score, with highest area under the curve, was the cutoff to differentiate responders from nonresponders. Conclusion: The evolution of CAT scores during exacerbation can provide useful information to assess the health status of patients with AECOPD. A 3.5-unit improvement in CAT score is the best cutoff to differentiate between patients who have a response or no response to treatment, which offers a convenient and easy way for clinicians to monitor the health status of patients with an AECOPD. Keywords: COPD, acute exacerbation, CAT, curative effect Dovepress International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Zhou et al treatment, it is essential to find an efficient tool to evaluate the curative effect of the therapy. As we all know, the diagnosis, stage of severity, and treatment recommendations of COPD have been guided by the degree of airflow limitation (ie, the ratio of FEV1 and FVC, and FEV1%) for many years.13 However, COPD is a heterogeneous disease, and spirometry only captures some of the disease variety.14,15 In addition, a study16 showed the airway function of some patients could not return to preexacerbation levels within 91 days, which indicates lung function was not able to sensitively reflect the health status of the patients. Thus, to better classify the patients for prognostic purposes and to guide treatment, the GOLD 201117 Executive Summary made great modifications in the disease classification. Instead of relying on FEV1 only, it classified the patients according to the level of dyspnea, exacerbation history, and FEV1, which pointed out the importance of clinical symptoms. The CAT and mMRC dyspnea scale were the main questionnaires to evaluate the symptoms in the GOLD document. mMRC is a simple questionnaire that can only evaluate the dyspnea of the patient.18 However, the impact of COPD on individuals is multifaceted and it causes impairment not only in the lungs but also in other organs, and even psychological conditions.17 The CAT was designed by Jones et al19 in 2009, and it consists of eight items, including cough, expectoration, dyspnea, chest tightness, confidence, limitation of daily activities, quality of sleep, and levels of energy. The score of each item ranges from 0 to 5 (0=no impairment, 5=greatest impairment). The total score is calculated by adding the points of the eight questions ranging from 0 to 40, where 0 means the best status and 40 means the worst status. This questionnaire is completed by the patients themselves, and it can assess the impact of COPD on the health status of patients within a few minutes. In (...truncated)