Respiratory Symptoms Items from the COPD Assessment Test Identify Ever-Smokers with Preserved Lung Function at Higher Risk for Poor Respiratory Outcomes. An Analysis of the Subpopulations and Intermediate Outcome Measures in COPD Study Cohort.

MS#: 
MS078
TitleRespiratory Symptoms Items from the COPD Assessment Test Identify Ever-Smokers with Preserved Lung Function at Higher Risk for Poor Respiratory Outcomes. An Analysis of the Subpopulations and Intermediate Outcome Measures in COPD Study Cohort.
Publication TypePublication
Year2017
AuthorsMartinez CH, Murray S, R Barr G, Bleecker E, Bowler RP, Christenson SA, Comellas AP, Cooper CB, Couper D, Criner GJ, Curtis JL, Dransfield MT, Hansel NN, Hoffman EA, Kanner RE, Kleerup E, Krishnan JA, Lazarus SC, Leidy NK, O'Neal W, Martinez FJ, Paine R, Rennard SI, Tashkin DP, Woodruff PG, Han MK
Corporate AuthorsSubpopulations and Intermediate Outcome Measures in COPD Study Investigators
JournalAnn Am Thorac Soc
Volume14
Issue5
Pagination636-642
Date Published2017 May
ISSN2325-6621
KeywordsAged, biomarkers, Cross-Sectional Studies, Disease Progression, Female, Forced Expiratory Volume, Humans, Longitudinal Studies, Lung, Male, Middle Aged, Outcome Assessment (Health Care), Prospective Studies, Pulmonary Disease, Chronic Obstructive, quality of life, ROC Curve, Severity of Illness Index, smoking, Spirometry, Surveys and Questionnaires, United States, Vital Capacity
Abstract

RATIONALE: Ever-smokers without airflow obstruction scores greater than or equal to 10 on the COPD Assessment Test (CAT) still have frequent acute respiratory disease events (exacerbation-like), impaired exercise capacity, and imaging abnormalities. Identification of these subjects could provide new opportunities for targeted interventions.OBJECTIVES: We hypothesized that the four respiratory-related items of the CAT might be useful for identifying such individuals, with discriminative ability similar to CAT, which is an eight-item questionnaire used to assess chronic obstructive pulmonary disease impact, including nonrespiratory questions, with scores ranging from 0 to 40.METHODS: We evaluated ever-smoker participants in the Subpopulations and Intermediate Outcomes in COPD Study without airflow obstruction (FEV/FVC ≥0.70; FVC above the lower limit of normal). Using the area under the receiver operating characteristic curve, we compared responses to both CAT and the respiratory symptom-related CAT items (cough, phlegm, chest tightness, and breathlessness) and their associations with longitudinal exacerbations. We tested agreement between the two strategies (κ statistic), and we compared demographics, lung function, and symptoms among subjects identified as having high symptoms by each strategy.RESULTS: Among 880 ever-smokers with normal lung function (mean age, 61 yr; 52% women) and using a CAT cutpoint greater than or equal to 10, we classified 51.8% of individuals as having high symptoms, 15.3% of whom experienced at least one exacerbation during 1-year follow-up. After testing sensitivity and specificity of different scores for the first four questions to predict any 1-year follow-up exacerbation, we selected cutpoints of 0-6 as representing a low burden of symptoms versus scores of 7 or higher as representing a high burden of symptoms for all subsequent comparisons. The four respiratory-related items with cutpoint greater than or equal to 7 selected 45.8% participants, 15.6% of whom experienced at least one exacerbation during follow-up. The two strategies largely identified the same individuals (agreement, 88.5%; κ = 0.77; P < 0.001), and the proportions of high-symptoms subjects who had severe dyspnea were similar between CAT and the first four CAT questions (25.9% and 26.8%, respectively), as were the proportions reporting impaired quality of life (66.9% and 70.5%, respectively) and short walking distance (22.4% and 23.1%, respectively). There was no difference in area under the receiver operating characteristic curve to predict 1-year follow-up exacerbations (CAT score ≥10, 0.66; vs. four respiratory items from CAT ≥7 score, 0.65; P = 0.69). Subjects identified by either method also had more depression/anxiety symptoms, poor sleep quality, and greater fatigue.CONCLUSIONS: Four CAT items on respiratory symptoms identified high-risk symptomatic ever-smokers with preserved spirometry as well as the CAT did. These data suggest that simpler strategies can be developed to identify these high-risk individuals in primary care.

DOI10.1513/AnnalsATS.201610-815OC
Alternate JournalAnn Am Thorac Soc
PubMed ID28459622
PubMed Central IDPMC5427740
Grant ListHHSN268200900019C / HL / NHLBI NIH HHS / United States
HHSN268200900009C / WH / WHI NIH HHS / United States
P30 ES005605 / ES / NIEHS NIH HHS / United States
K23 HL128936 / HL / NHLBI NIH HHS / United States
K24 HL137013 / HL / NHLBI NIH HHS / United States
HHSN268200900015C / HL / NHLBI NIH HHS / United States
HHSN268200900016C / HL / NHLBI NIH HHS / United States
I01 CX000911 / CX / CSRD VA / United States
U01 HL137880 / HL / NHLBI NIH HHS / United States
R01 HL122438 / HL / NHLBI NIH HHS / United States
HHSN268200900018C / HL / NHLBI NIH HHS / United States
P30 DK054759 / DK / NIDDK NIH HHS / United States
HHSN268200900017C / HL / NHLBI NIH HHS / United States
HHSN268200900020C / HL / NHLBI NIH HHS / United States
HHSN268200900013C / HL / NHLBI NIH HHS / United States
HHSN268200900014C / HL / NHLBI NIH HHS / United States
Manuscript Lead/Corresponding Author Affiliation: 
Clinical Center: Michigan (University of Michigan)
ECI: 
Manuscript Status: 
Published