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Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort
Journal article   Open access   Peer reviewed

Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort

Marni Stott-Miller, Hana Mullerova, Bruce Miller, Maggie Tabberer, Celine El Baou, Tom Keeley, Fernando J. Martinez, Meilan Han, Mark Dransfield, Nadia N. Hansel, …
International journal of chronic obstructive pulmonary disease, Vol.15, pp.2467-2476
01/01/2020
DOI: 10.2147/COPD.S267002
PMCID: PMC7568676
PMID: 33116463
url
https://doi.org/10.2147/COPD.S267002View
Published (Version of record) Open Access

Abstract

Background: Chronic cough and phlegm are frequently reported chronic obstructive pulmonary disease (COPD) symptoms. Prior research classified chronic mucus hypersecretion (CMH) based on the presence of these symptoms for >= 3 months, called chronic bronchitis (CB) if respiratory infection symptoms were present for 1-2 years (Medical Research Council [MRC] definition). We explored whether the COPD Assessment Test (CAT), a simple measure developed for routine clinical use, captures CMH populations and outcomes similarly to MRC and St. George's Respiratory Questionnaire (SGRQ) definitions. Methods: We identified CMH in the SPIROMICS COPD cohort using (a) MRC definitions, (b) SGRQ questions for cough and phlegm (both as most/several days a week), and (c) CAT cough and phlegm questions. We determined optimal cut-points for CAT items and described exacerbation frequencies for different CMH definitions. Moderate exacerbations required a new prescription for antibiotics/oral corticosteroids or emergency department visit; severe exacerbations required hospitalization. Results were stratified by smoking status. Results: In a population of 1431 participants (57% male; mean FEV1% predicted 61%), 47% and 49% of evaluable participants had SGRQ- or CAT-defined CMH, respectively. A cut-point of >= 2 for cough and phlegm items defined CMH in CAT. Among SGRQ-CMH+ participants, 80% were also defined as CMH+ by the CAT. CMH+ participants were more likely to be current smokers. A higher exacerbation frequency was observed for presence of CMH+ versus CMH- in the year prior to baseline for all CMH definitions; this trend continued across 3 years of follow-up, regardless of smoking status. Conclusion: Items from the CAT identified SGRQ-defined CMH, a frequent COPD trait that correlated with exacerbation frequency. The CAT is a short, simple questionnaire and a potentially valuable tool for telemedicine or real-world trials. CAT-based CMH is a novel approach for identifying clinically important characteristics in COPD that can be ascertained in these settings.
 Respiratory System Life Sciences & Biomedicine Science & Technology

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