Chronic obstructive pulmonary disease assessment test: usefulness for monitoring recovery and predicting poor course of disease after exacerbations
Pulido Herrero E, García Gutiérrez S, Antón Ladislao A, Piñera Salmerón P, Martín Corral MJ, Gorordo Unzueta MI, Lopetegui Eraso P, García Lamberechts EJ, Quintana López JM
Affiliation of the authors
Emergency Department, OSI-Barrualdea-Galdakao, Galdakao, Bizkaia. Network Research in Services of Health in Chronic Diseases [REDISSEC], Galdakao, Bizkaia, Spain. Research Department, OSI Barrualde-Galdakao, Galdakao, Bizkaia. Emergency Department, Hospital Reina Sofia, Murcia, Spain. Pneumology Service, OSI Barrualde_Galdakao, Galdakao, Bizkaia, Spain. Hospital Emergency Department of Txagorritxu, Vitoria, Alava, Spain. Emergency Department of Hospital Clínico San Carlos, Madrid, Spain.
Pulido Herrero E, García Gutiérrez S, Antón Ladislao A, Piñera Salmerón P, Martín Corral MJ, Gorordo Unzueta MI, et al. Chronic obstructive pulmonary disease assessment test: usefulness for monitoring recovery and predicting poor course of disease after exacerbations. Emergencias. 2019;31:21-26
Summary
Objectives.
To assess the usefulness of the chronic obstructive pulmonary disease (COPD) assessment test (CAT) for evaluating recovery from an acute exacerbation of chronic COPD. To assess whether the CAT score used along with a COPD exacerbation severity scale can better predict risk of a poor course of disease.
Methods.
Prospective multicenter cohort study enrolling patients who attended hospital emergency departments with symptoms of exacerbated COPD. We recorded sociodemographic and clinical data and information from 2 questionnaires: the CAT and the modified dyspnea scale of the Medical Research Council (mMRC). Measures of clinical outcome in this study were the CAT score 2 months after the COPD exacerbation and poor course of disease during the hospital stay or 1 week after discharge from the emergency department if patients were not hospitalized.
Results.
The cohort included 501 patients. The median (interquartile range) CAT score was 13 (7–18) on the day before the exacerbation, 25 (19–30) during emergency care for the exacerbation, and 13 (7–18) 2 months later. The difference between the CAT scores before the exacerbation and 2 months later was not statistically significant when the cohort was stratified by severity of baseline COPD (mild, moderate, and severe/very severe) (P=.585, P=.419, and P=.4357). The short-term course of disease was poor for 91 patients (18.16%). Combining the mMRC and the CAT scores to predict poor short-term outcome gave an area under the receiver operating characteristic curve (AUC) of 0.701 (95% CI, 0.640–0.762). The AUC for the mMRC score without the CAT score was 0.667 (95% CI, 0.616–0.737). The difference between the AUCs was not statistically significant (P=.088).
Conclusions.
The CAT score may be useful for monitoring recovery from a COPD exacerbation. Combining the CAT score and a COPD severity score may be useful for predicting clinical course after an exacerbation.
