The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD
Received 25 June 2015
Accepted for publication 14 September 2015
Published 30 November 2015 Volume 2015:10(1) Pages 2571—2579
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 4
Editor who approved publication: Dr Richard Russell
Marc Miravitlles,1 Patricia García-Sidro,2 Alonso Fernández-Nistal,3 María Jesús Buendía,4 María José Espinosa de los Monteros,5 Cristina Esquinas,1 Jesús Molina6
1Pneumology Department, Hospital Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias, Barcelona, 2Pneumology Unit, Hospital de la Plana, Villareal, 3Medical Department, Takeda Farmacéutica España S.A., Madrid, 4Pneumology Department, Hospital Universitario Infanta Leonor, Madrid, 5Pneumology Department, Hospital Universitario Virgen de la Salud, Toledo, 6Centro de Salud “Francia”, Fuenlabrada, Madrid, Spain
Introduction: Chronic obstructive pulmonary disease (COPD) exacerbations have a negative impact on the quality of life of patients and the evolution of the disease. We have investigated the prognostic value of several health-related quality of life questionnaires to predict the appearance of a composite event (new ambulatory or emergency exacerbation, hospitalization, or death) over a 1-year follow-up.
Methods: This was a multicenter, prospective, observational study. Patients completed four questionnaires after recovering from an exacerbation (COPD Assessment Test [CAT], a Clinical COPD Questionnaire [CCQ], COPD Severity Score [COPDSS], and Airways Questionnaire [AQ20]). Patients were followed-up until the appearance of the composite event or for 1 year, whichever came first.
Results: A total of 497 patients were included in the study. The majority of them were men (89.7%), with a mean age of 68.7 (SD 9.2) years, and a forced expiratory volume in 1 second of 47.1% (SD 17.5%). A total of 303 (61%) patients experienced a composite event. Patients with an event had worse mean scores of all questionnaires at baseline compared to patients without event: CAT=12.5 vs 11.3 (P=0.028); CCQ=2.2 vs 1.9 (P=0.013); COPDSS=12.3 vs 10.9 (P=0.001); AQ20=8.3 vs 7.5 (P=0.048). In the multivariate analysis, only previous history of exacerbations and CAT score ≥13.5 were significant risk factors for the composite event. A CAT score ≥13.5 increased the predictive value of previous exacerbations with an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.829–0.899; P=0.001).
Conclusion: The predictive value of previous exacerbations significantly increased only in one of the four trialled questionnaires, namely in the CAT questionnaire. However, previous history of exacerbations was the strongest predictor of the composite event.
Keywords: COPD, CAT, CCQ, COPDSS, AQ20, exacerbations
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