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

Carlos H Martinez; Susan Murray; R Graham Barr; Eugene Bleecker; Russell P Bowler; Stephanie A Christenson; Alejandro P Comellas; Christopher B Cooper; David Couper; Gerard J Criner; Jeffrey L Curtis; Mark T Dransfield; Nadia N Hansel; Eric A Hoffman; Richard E Kanner; Eric Kleerup; Jerry A Krishnan; Stephen C Lazarus; Nancy K Leidy; Wanda O'Neal; Fernando J Martinez; Robert Paine III; Stephen I Rennard; Donald P Tashkin; Prescott G Woodruff; MeiLan K Han

doi:10.1513/AnnalsATS.201610-815OC

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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

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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

Carlos H Martinez, Susan Murray, R Graham Barr, Eugene Bleecker, Russell P Bowler, Stephanie A Christenson, Alejandro P Comellas, Christopher B Cooper, David Couper, Gerard J Criner, …

Annals of the American Thoracic Society, Vol.14(5), pp.636-642

05/2017

DOI: 10.1513/AnnalsATS.201610-815OC

PMCID: PMC5427740

PMID: 28459622

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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 (FEV1/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.

Biomarkers

Quality of Life

United States

Severity of Illness Index

Smoking - adverse effects

Spirometry

Prospective Studies

Cross-Sectional Studies

Outcome Assessment (Health Care)

Humans

Middle Aged

Male

Lung - physiopathology

Pulmonary Disease, Chronic Obstructive - physiopathology

Disease Progression

Forced Expiratory Volume

Vital Capacity

Smoking - physiopathology

Female

ROC Curve

Surveys and Questionnaires

Aged

Longitudinal Studies

Details

Title: Subtitle: 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
Creators: Carlos H Martinez - 1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan
Susan Murray - 2 School of Public Health, University of Michigan, Ann Arbor, Michigan
R Graham Barr - 4 Department of Epidemiology, Columbia University Medical Center, New York, New York
Eugene Bleecker - 5 Center for Genomics and Personalized Medicine Research, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
Russell P Bowler - 6 Department of Medicine, National Jewish Health, Denver, Colorado
Stephanie A Christenson - 7 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
Alejandro P Comellas - 8 Division of Pulmonary, Critical Care and Occupational Medicine, Department of Internal Medicine
Christopher B Cooper - 9 Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
David Couper - 10 Department of Biostatistics and
Gerard J Criner - 11 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
Jeffrey L Curtis - 12 Medicine Service, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
Mark T Dransfield - 14 UAB Lung Health Center, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Nadia N Hansel - 15 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
Eric A Hoffman - 17 Department of Biomedical Engineering, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Richard E Kanner - 18 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
Eric Kleerup - 9 Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Jerry A Krishnan - 19 Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, Illinois
Stephen C Lazarus - 7 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
Nancy K Leidy - 20 Office of Scientific Affairs, Evidera, Bethesda, Maryland
Wanda O'Neal - 21 Department of Internal Medicine, Weill Cornell Medical College, New York, New York; and
Fernando J Martinez - 22 Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Robert Paine III - 18 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
Stephen I Rennard - 23 Division of Pulmonary, Critical Care, Sleep and Allergy, University of Nebraska Medical Center, Omaha, Nebraska
Donald P Tashkin - 7 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
Prescott G Woodruff - 7 Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California
MeiLan K Han - 1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan
Resource Type: Journal article
Publication Details: Annals of the American Thoracic Society, Vol.14(5), pp.636-642
DOI: 10.1513/AnnalsATS.201610-815OC
PMID: 28459622
PMCID: PMC5427740
NLM abbreviation: Ann Am Thorac Soc
ISSN: 2325-6621
eISSN: 2325-6621
Publisher: American Thoracic Society; United States
Grant note: HHSN268200900017C / NHLBI NIH HHS P30 ES005605 / NIEHS NIH HHS HHSN268200900019C / NHLBI NIH HHS HHSN268200900020C / NHLBI NIH HHS U01 HL137880 / NHLBI NIH HHS HHSN268200900015C / NHLBI NIH HHS I01 CX000911 / CSRD VA HHSN268200900013C / NHLBI NIH HHS R01 HL122438 / NHLBI NIH HHS K24 HL137013 / NHLBI NIH HHS HHSN268200900016C / NHLBI NIH HHS K23 HL128936 / NHLBI NIH HHS HHSN268200900018C / NHLBI NIH HHS HHSN268200900014C / NHLBI NIH HHS HHSN268200900009C / WHI NIH HHS P30 DK054759 / NIDDK NIH HHS
Language: English
Date published: 05/2017
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Radiology; Pulmonary, Critical Care, and Occupational Medicine; ICTS; Internal Medicine
Record Identifier: 9984051789902771

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