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    COPD Assessment Test (CAT)

    Quantifies impact of COPD symptoms on patients' overall health.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Use in patients diagnosed with COPD, to assess progression of lung disease, decline in functional status, and gauge effectiveness of pulmonary rehabilitation.

    • Developed to address COPD burden in daily life, not to diagnose COPD.

    • CAT scores have been shown to correlate with mortality (Husebø 2016) as well as patient-reported symptom improvement (Dodd 2011).

    • Provides a validated and universally agreed-upon framework for quantifying symptom burden and risk for exacerbation (along with spirometry), which can be used to guide therapy.

    • Recommended by GOLD Guidelines 2018 (along with the mMRC Dyspnea Scale) for evaluation of all patients with COPD.

    • Quicker and more practical to complete than other questionnaire-based assessments such as St. George’s Respiratory Questionnaire or Chronic Respiratory Questionnaire.

    0 (“I never cough”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“I cough all the time”)
    +5
    0 (“I have no phlegm in my chest at all”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“My chest is completely full of phlegm”)
    +5
    0 (“My chest does not feel tight at all”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“My chest feels very tight”)
    +5
    0 (“When I walk up a hill or one flight of stairs I am not breathless”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“When I walk up a hill or one flight of stairs I am very breathless”)
    +5
    0 (“I am not limited doing any activities at home”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“I am very limited doing any activities at home”)
    +5
    0 (“I am confident leaving my home despite my lung condition”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“I am not at all confident leaving my home because of my lung condition”)
    +5
    0 (“I sleep soundly”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“I don’t sleep soundly because of my lung condition”)
    +5
    0 (“I have lots of energy”)
    0
    1
    +1
    2
    +2
    3
    +3
    4
    +4
    5 (“I have no energy at all”)
    +5

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Note that the CAT is one component in clinical decision-making, along with other considerations such as history of previous exacerbations and airflow limitation (FEV1).

    • For all COPD patients, smoking cessation, preventive care (e.g. annual flu/pneumococcal vaccinations), and reduced exposure to exacerbation risk factors are mainstays of management (GOLD Guidelines 2018).

    • GOLD Guidelines (2018) recommend CAT as one component in grading symptom burden and to categorize patients into one of four groups A-D. 
    • CAT ≥10 corresponds to either GOLD Group B or D. Group B patients’ preferred treatment is to start either on LABA, or LAMA and if persistent symptoms then combination LAMA/LABA therapy—these are the minimum for patients with CAT Score ≥10. 
    • CAT <10 corresponds to GOLD Group A or C. Group A patients’ preferred treatment is to start bronchodilator (LABA or LAMA) and evaluate the effect. 

    Management

    Most hospitals have particular COPD exacerbation order sets or guidelines for their management of COPD exacerbations, including which inhalers are readily available. Management typically includes:

    • ICS, LABA, LAMA, and short acting bronchodilator inhalers along with systemic corticosteroids and antibiotics x 5 days.

    • Oxygen supplementation for saturation <88%, continuous pulse oximetry.

    • Smoking cessation counseling.

    • Pulmonary consultation.

    Critical Actions

    • It is assumed that changes in score ≥2 points suggest a clinically significant difference. However, this has not been confirmed with data and is a major limitation.

    • Furthermore, as COPD is a progressive lung disease, there is no fixed target score for all patients. Worsening CAT scores may indicate that patients are experiencing exacerbations that they have not reported, or may indicate non-compliance with treatment or patient not using proper technique to effectively take their medication.

    Content Contributors
    • Sachin Patel, MD
    Reviewed By
    • Wael Nasser, MD
    About the Creator
    Dr. Paul W. Jones
    Are you Dr. Paul W. Jones?
    Content Contributors
    • Sachin Patel, MD
    Reviewed By
    • Wael Nasser, MD