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Background: CAT scores can be used to assess the effects of COPD on patient health status. Within a study cohort, higher CAT scores are associated with more frequent exacerbations (Kelly JF, et al. Respiration 2012;84:193–9) and predict exacerbations in patients at risk (Lee SD, et al. Respir Med 2014;108:600–8). Aim: To compare individual CAT item scores in cohorts with differing risk of exacerbation from two COPD trials. Methods: Data from the EMAX and IMPACT trials were used as baseline differences between these trials in total CAT score were small, but differences in exacerbation rates were large (Figure 1). The analysis was post hoc without statistical comparisons. Results: Compared with IMPACT, EMAX patients had less severe airflow limitation and a greater proportion were current smokers (Figure 1); however, individual CAT item scores were similar between the trials (Figure 2). Conclusion: Despite differences in exacerbation history of the two cohorts, mean individual CAT item scores were similar. Method: GSK (201749, NCT03034915; 116855, NCT02164513)

Introduction: The separation of the degree of obstruction in spirometry from the symptoms and exacerbations was a step towards more personalized and targeted treatment in COPD patients. Despite these recent changes, criticism of this model has also emerged.One is based on the choice of the tool used to measure the symptoms, either the Medical Research Council9s modified dyspnea scale (mMRC) or the COPD Assessment Test questionnaire (CAT). Objective: The GOLD strategy considered an mMRC dyspnea scale of 2 and a CAT score of 10 to be equivalent, despite the fact that there were no studies to support these data. The aim of our study is to determinate whether the classification of COPD patients into a group ABCD could change depending on assessment tool used. Methods: Observational study of COPD patients. The classification in the ABCD group was performed twice using the two recommendation tools to measure the symptoms. The degree of agreement between the results of applying both methods was analyzed. Results: 169 COPD subjects were included. Using the mMRC to classify patients into ABCD groups, 108 (63.9%) patients were assigned to group A, 18 (10.7%) to group B, 25 (14.8%) to group C and 18 (10.7%) to group D. The categorization of patients according to CAT obtained that 61 (36.1%) were assigned to group A, 65 (38.5%) to group B, 12 (7.1%) to group C and 31 (18.3%) to group D.The degree of agreement was obtained with a Kappa value of 0.492 (moderate agreement). Conclusions: In our study, 35.51% of the subjects when classified by CAT and mMRC did not agree on their assignment within the groups A, B, C and D of the GOLD recommendations. Our study suggests the fact that the assignment of the patients in a group could changes depending on the symptom-measuring tool used.

Introduction: PROMS (Patient Reported Outcomes Measures) are self-report questionnaires, completed by patients, which seek to measure their perception of their health status and health-related quality of life. The most popular tools used by pulmonologists to evaluate the stage of COPD are CAT (COPD Assessment Test) and mMRC scale. FEV1 is used to assess the severity of airflow obstruction. Aim-Objectives: To investigate the possible correlation of CAT score, mMRC and FEV1 to the number of acute exacerbations of COPD (AECOPD) per year. Methods: This is a retrospective study which included patients diagnosed with stable COPD disease based on symptoms and post-bronchodilator airflow limitation as it was depicted by spirometry. History of AECOPD in the last three years was collected. Results: One hundred thirteen COPD patients were included in the study. Patients’ demographic data and clinical characteristics are shown in Table 1. CAT score and mMRC scale were positively correlated to the number of AECOPD (r=0,428, p=0,000 and r=0,450, p=0,000 respectively). Additionally, FEV1%pred was negatively correlated to the number of AECOPD (r=-0,274, p=0,004). CAT score was positively correlated to mMRC scale (r=0,59, p=0,000). Interestingly, CAT score and mMRC scale were negatively correlated to FEV1 % pred (r= -0,454, p=0,000 and r=-0,467, p=0,000 respectively). Conclusion: Based on our data, CAT score, mMRC and FEV1% pred could be used as predictors of AECOPD.

Fatigue is a prevalent, multi-dimensional and burdensome symptom in chronic obstructive pulmonary disease (COPD), yet it is still underdiagnosed, undertreated and little understood. This study explored associations between fatigue and key outcomes in COPD and which of them could explain fatigue. A cross-sectional study with people with COPD was conducted. Assessments included the modified functional assessment of chronic illness therapy-fatigue subscale (mod-FACIT-FS; lower scores mean worst fatigue), modified Medical Research Council dyspnea scale (mMRC), six-minute walk test (6MWT), COPD assessment test (CAT) and St. George’s Respiratory Questionnaire (SGRQ). Correlations were explored with the Pearson’s (r)/Spearman’s (rs) coefficients. Multiple linear regressions were performed with the stepwise model and the variance inflation factor (VIF) was confirmed. 89 people with COPD (68±9years; 76%male; 50±18FEV1pp) were enrolled. Significant moderate correlations were found between the mod-FACIT-FS and all outcomes (mMRC:rs=-0.53; 6MWT:r=0.50; CAT:r=-0.56; SGRQ:r=-0.63; p

Background: This is an extension study of the Predictive Ability of COPD Assessment Test (CAT) in acute Exacerbations of COPD (PACE) study. Aims and Objective: We want to find out if there is a positive relationship between CAT and exacerbation in COPD. Method: This study was an extension study of GSK sponsored study (SAM114169). Between Aug 2010 and Dec 2011, a total of 162 subjects visited institutions over 52 wks. At every visit, they completed the CAT, MRC, Exacerbation Check List (ECL), and spirometry. Telephone calls were made at every eight weeks intervals to collect information on exacerbation episodes in the previous month. Baseline CAT scores were categorized into 4 categories (0-9, 10-19, 20-29, 30-40). Age, gender, MRC, post BD FEV1, COPD exacerbation history, smoking history, flu vaccination history, etc. were adjusted. Results: In the adjusted analysis, categorized baseline CAT score showed a positive relationship with COPD exacerbation, not statistically significant but numerically increasing tendency (p=0.057). The patients with the highest category (CAT score 30-40) showed a trend towards higher risk of COPD exacerbations(aRR:1.16; p=0.043) than those in the lowest category (CAT score 0-9). Meanwhile, in the moderate/severe COPD exacerbation, this relationship remained as statistically significant after adjustment (p=0.002). The patients in the highest category showed higher risk of having meaningful COPD exacerbations (aRR:1.69; p=0.004) than those in the lowest category. Conclusion: The baseline CAT score showed a positive relationship with COPD exacerbation. We can conclude that CAT can be used as a useful tool for physicians to predict COPD exacerbations. Funding: GSK (NCT01254032)

We postulated that the COPD Helplessness Index (CHI), used to measure factors affecting patient self-management (Omachi et al, 2010), could help to assess the improvement in self-management skills of COPD patients before and after a pulmonary rehabilitation program (PRP). Methods: Forty five COPD patients (mean age 66.3±9.3 years, 21 females, mean BODE score 3.5±0.3) consecutively enrolled in a PRP were studied. We recorded mMRC, COPD assessment test (CAT), Hospital-Anxiety Depression score (HADS), Visual Simplified Respiratory Questionnaire (VSRQ) and the 6-min walking test (m, 6MWT). A French translation of the CHI was shortened into the 5 items with the higher item-total correlation (sCHI): “I can’t successfully manage my breathing problems (BP)”; “I can’t cope with my BP”; “my BP control my life” ; “I don’t have the ability to control my BP”; “no matter what I do, I can’t get relief from my BP”. Responses are rated on a 5-point Likert scale and range from 1 (fully disagree) to 5 (fully agree); the obtained value is 5 to 25, a higher score indicating poorer self-management. Results: The following variations (mean±SD, p Conclusions: The sCHI may help to assess improvement in patients’ self-management after an effective PRP.

Introduction: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major events with negative impact on the course of the disease that need to be properly evaluated. COPD Assessment Test (CAT) has been showed to be responsive to AECOPD. Aims: To evaluate CAT responsiveness to AECOPD recovery and to investigate the influence of patients characteristics on CAT recovery. Methods: Patients previously diagnosed with COPD who were admitted in emergency department of a tertiary hospital due to AECOPD were included. CAT was performed at admission and 30 days after discharge. Clinical data and readmissions were recorded. Results: 111 patients were enrolled. 77.4% were male, mean of forced expiratory volume in one second (FEV1) was 49.2 ± 15.2% and majority of patients were GOLD D (36.0%) or C (21.6%). 63.5% were treated as inpatients and mean length of hospitalization was 11.5±11.1 days. 19.8% were readmitted 30 days after discharge due to AECOPD and from these, the majority needed hospitalization for treatment. Mean CAT score at admission was 22.0±6.2, 30 days after discharge was 18.4±6.8 and mean CAT recovery was 3.6±3.7 (p Conclusions: CAT is an useful tool to evaluate AECOPD recovery. CAT score recovery following AECOPD is influenced by BMI.

Background: The GOLD classification for COPD recommend the use of CAT or mMRC dyspnea scores for symptoms. The aim of this study was to evaluate classification of COPD by symptom scales: CAT in its Arabic version vs mMRC and study the correlation of this questionary with « mMRC » dyspnea scale Methods: prospective study including patients with COPD from January to September 2017. These patients responded to the CAT self-questionnaire. Dyspnea was evaluated accordoing to mMRC scale. Results: A total of 50 patients were included with an average age of 66 + 11.7 years. Dyspnea was stage 0 in 6 % of patients, stage 1 in 10 %, stage 2 in 8 %, stage 3 in 34 % and stage 4 in 42 % of patients. The mean CAT score in our patients was 23.3 + 9.3. By using CAT score 6% of patients were assigned to group A, 6% to group B, 6% to group C and 82% to group D. On the basis of the mMRC scale, 8% were assigned to group A, 4% to group B, 8% to group C and 80 % to group D. The kappa of agreement for the GOLD groups classified by CAT and mMRC was 0.745; p Conclusion: The classification of COPD produced by the mMRC or CAT score was not completely identical. Care should be taken when stratifying COPD patients with one symptom scale versus another.

Introduction: COPD assessment test (CAT) is a short, easy-to-complete health status tool that has been incorporated into the multidimensional assessment of chronic obstructive pulmonary disease (COPD) in order to guide therapy; therefore, it is important to understand the factors determining CAT scores. Objective: This study intended to clarify how different COPD patients characteristics influence the CAT scores. Methods: This is a retrospective study conducted in respiratory medicine department with the aim of identifying the factors determining CAT scores, focusing particularly on the nutritional status, levels of anxiety and depression and the 6-minute walk distance (6MWD). The 38 Participants were classified into two groups by the mean value of CAT. Results: Compared with those with CAT Conclusion: CAT scores are associated with clinical variables of severity of COPD. Our results demonstrate the correlation between CAT scores and anxiety, depression and 6MWD.

The association between clinically relevant changes in patient-reported outcomes (PROs) and forced expiratory volume in 1 s (FEV1) in patients with chronic obstructive pulmonary disease (COPD) has rarely been investigated. Using CRYSTAL, a 12-week open-label study in symptomatic, nonfrequently exacerbating patients with moderate COPD, we assessed at baseline the correlations between several PROs (Baseline Dyspnoea Index, modified Medical Research Council dyspnoea scale, COPD Assessment Test (CAT) and Clinical COPD Questionnaire (CCQ)), and between FEV1 and PROs. Associations between clinically relevant responses in FEV1, CAT, CCQ and Transition Dyspnoea Index (TDI) at week 12 were also assessed. Using data from 4324 patients, a strong correlation was observed between CAT and CCQ (rs=0.793) at baseline, with moderate or weak correlations between other PROs, and no correlation between FEV1 and any PRO. At week 12, 2774 (64.2%) patients were responders regarding TDI, CAT or CCQ, with 583 (13.5%) responding using all three measures. In comparison, 3235 (74.8%) were responders regarding FEV1, TDI, CAT or CCQ, with 307 (7.1%) responding concerning all four parameters. Increases in lung function were accompanied by clinically relevant improvements of PROs in a minority of patients. Our results also suggest that PROs are not interchangeable. Thus, the observed treatment success in a clinical trial may depend on the selected parameters., Assessments of both lung function and various patient-reported outcomes in clinical trials may be necessary for a more complete picture of treatment response in patients with COPD and to guide treatment decisions http://ow.ly/msoz30nmupG

Introduction: COPD Assessment Test (CAT) is a patient-completed questionnaire widely used to quantify COPD impact.Unfortunately, completion of the questionnaire by the elderly patients alone is often limited due to multiple reasons. Aim: Assessment of concordance between the perception of symptoms severity directly by patients and indirectly by patients with explanatory assistance of their pulmonologists. Methods: A cross-sectional, descriptive, multicenter study conducted in out-patients. Patients’ attitudes are represented by patient-completed CAT score (step 1) in the waiting room. The CAT score was re-evaluated following question clarification by a physician (step 2). Additionally, Modified Medical Research Council (mMRC) dyspnea scale was used as well. Results: A total of 382 COPD consecutive pts were included in this study (74%males, 68 years, FEV1 49.7%) by physicians in out-patient clinics. The mMRC dyspnea scale directly reported by COPD patients and mMRC dyspnea scale assessed with physician assistance did not differ. Nevertheless, CAT scores self-reported by patients (median16.0, mean16.4) were significantly (p Conclusions: Minor physician assistance in CAT questionnaire evaluations had tendency to underestimate the symptoms and impact of disease to the patient. Similar trend was not visible in mMRC dyspnea scale.

Background: Sarcopenia is defined as the loss of skeletal muscle mass and muscle strength that occurs with advancing age. It is also recognized as one of the complications of COPD. Japan is now aging more rapidly than anywhere else in the world. Purpose: To evaluate the prevalence of sarcopenia in Japanese COPD patients and determine whether sarcopenia correlates with the severity of COPD Methods: 61 out-patients (57 males / 4 females, mean age 73.7 ± 7.3) who received treatment with COPD were studied. After a 6-minute walk test (6 MWT) and grip strength measurement, body composition was measured through the bioelectrical impedance analysis (BIA) method to calculate SMI. The diagnosis of Sarcopenia was conducted by the diagnostic criteria of the Asian Working Group for Sarcopenia. We also attempted to determine whether SMI correlates with FEV1.0, modified British Medical Research Council questionnaire (mMRC), COPD Assessment Test (CAT), serum albumin and prealbumin. Results: Sarcopenia was confirmed in 19 of 61 (31.1%) patients. SMI showed a correlation with BMI (r = 0.83, P Conclusions: Sarcopenia was observed in 31.1% of Japanese COPD patients. It was increased as the degree of obstruction progressed. As sarcopenia was also observed 18.5% in the BMI> 25 group, early diagnosis by the BIA method is effective.

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with high morbidity and mortality. Quantification of symptoms and their impact on health status in IPF is important to assess disease severity and progression and to properly adjust palliative therapy. Unfortunately, there is yet no easy-to-use questionnaire for this purpose. In our daily clinical practice, we apply the COPD Assessment Test (CAT) to quantify symptoms of IPF and to facilitate clinical consultations. The aim of this study was to investigate the correlation between CAT, St. George’s Respiratory Questionnaire (SGRQ) and clinical and physiological parameters among patients with IPF. We retrospectively collected data from 87 patients with IPF from the interstitial lung disease clinic at Gentofte Hospital, Denmark. Forty-seven patients were on anti-fibrotic treatment and 40 were assessed at the time of diagnosis. Mean (SD) FVC % pred was 83.1% (20.4), DLco % pred was 45.0% (13.2), CAT score was 16.8 (6.8) points and SGRQ total score was 45.1 (19.8) points, indicating moderate disease. The CAT was strongly correlated with SGRQ total score (r=0.8, p In the absence of a disease-specific clinically applicable health status questionnaire in IPF, the CAT may provide a valid and valuable tool in daily clinical practice.

Introduction and Objectives: Compliance to treatment is a common problem when managing chronic diseases. The aim of this study is to assess the factors that affect medication adherence in patients with stable COPD and determine the relationship between medication adherence and symptom scores. Methods: Patients with stable COPD were included in the study. In addition to the demographic and socioeconomic data; Morisky Medication Adherence Scale (MMAS-8) score for compliance and COPD Assessment Test (CAT) score for symptom evaluation were performed. MMAS-8 is a self-reported questionnaire to assess compliance. Compliance is accepted as low between 0-5 points, moderate with 6-7 points and total with 8 points. Results: 83 (F/M: 11/72, mean age 62.8±8.9 yrs) stable COPD patients were included in the study. Mean MMAS-8 score was 4.83±1.6 and mean CAT score was 16.7±8.6. According to MMAS-8 scores, 46 patients had low compliance (55.4%) 37 were moderately compliant (44.6%). There were no totally adherent patients. There was no relationship between medication adherence and age, gender, education level or additional comorbid diseases. Patients with low medication adherence were observed to have higher CAT scores. The median CAT score of patients with low adherence was 20.5 (0-38), while it was 12 (0-32) ( p =0.001) in patients with moderate adherence. Furthermore, a negative correlation between CAT and MMAS-8 scores was observed (r=-0.384) ( p Conclusion: Since the patients with lower medication adherence have higher symptom scores, the importance of compliance should be reminded at each visit and the efforts should be placed to reinforce compliance.

Background: Malnourished COPD patients have higher healthcare use and poorer outcomes than those not at risk. NICE (CG101, CG32) and the national “COPD pathway” (www.malnutritionpathway.co.uk/copd) highlight the importance of managing malnutrition in COPD but evaluations of the impact locally need investigation. Aim: To investigate the effect of locally implementing the “COPD pathway” on the nutritional status, well-being and health care use of malnourished COPD patients in the community. Methods: 19 patients (75±9.4y) identified at high risk of malnutrition (BMI 18.3±3.1kg/m2) were initiated on the pathway and received dietary advice plus low volume, high protein oral nutritional supplements (600kcal, 36g protein) and followed up at 6 and 12 weeks. Malnutrition risk, health care use, health rating (bad – great, 0-10 scale), COPD assessment test (CAT) (0-40 scale), compliance and satisfaction were recorded for 12 weeks before and after implementation. Results: Implementation of the pathway led to a significant reduction in malnutrition risk (19 high risk to 10 high, 4 medium, 5 low) (p Conclusion: This local pilot suggests appropriate management of malnourished COPD patients in the community improves nutritional status, health and CAT rating with associated reductions in health care use. A larger project to explore the clinical and economic effects is required.

Introduction: The constant workrate test (CWRT) can be used to estimate improvement after pulmonary rehabilitation (PR) in patients with COPD. The initial endurance time (Tlim) should be within 180 and 480 seconds, but the consequences of a Tlim outside this range on the prognostic value of the CWRT have not been studied. We aimed at evaluating the effect of the initial Tlim on the predictive value of the CWRT. Methods: We studied COPD patients that had completed an 8-week PR program in our centre in 2014. All patients performed a pre- and post-PR CWRT on ergocycle at 80% of the maximal workrate reached on a previous incremental exercise test. Physiological characteristics and changes in COPD Assessment Test scores (ΔCAT) and endurance time (ΔTlim) after PR were compared in patients with an initial Tlim in the recommended range and those that did not. Results: 92 patients were included (52 males). Mean forced expiratory volume in 1 second (FEV1) was 50±16 percent predicted. 28 patients (30%) had initial Tlim outside the recommended range. Age, sex, FEV1, diffusion capacity, ΔCAT, ΔTlim and exacerbation rates pre- and post-RP were similar between the two groups (all p>0.05). However, there was a significant correlation between ΔTlim and ΔCAT in patients that had an initial Tlim in the recommended range (r=-0.44, p=0.01), but not in those that did not (r=0.27, p=0.20). Conclusion: Tlim values outside of the recommended range are frequent, and impair the ability of the CWRT to predict improvement in disease activity / quality of life following PR. This strengthens the recommendation of aiming at an initial Tlim value of 180-480 seconds.

Rationale: Little is known about the impact of an abnormal DLco ( Objective: To compare clinical and functional characteristics of active or former smokers without airway obstruction with or without emphysema and/or abnormal DLco. Methods: This is an observational study of active or former smokers that underwent a low dose CT scan (LDCT), pulmonary function tests, COPD assessment test (CAT) and 6 minute walking distance test (6MWD) . Patients were classified in 3 groups depending on the presence of visually detected radiological emphysema and DLco values (no-emphysema; emphysema with DLco>80%; emphysema with DLco Results: 168 patients were analyzed. Patients with emphysema had a higher CAT score (7.96 vs 5.95 p=0.002) and a greater fall in SpO2% post-6MWD (22.7% vs 4.2%, p=0,004) . In those with an abnormal DLco, CAT score are even higher (4.78 vs 9.36, p=0.01) and a greater % having a fall in the SpO2% (96.3% vs 94.4%, p=0.007). In this group there were more active smokers (69% vs. 50%, p=0.025), with lower mean predicted FEV1 (96.7 vs 105.2%, p=0.004) and higher residual volume/total lung capacity ratio (37.05 vs 32.44, p:0.05). Conclusion: In active or former smokers with emphysema, the presence of an abnormal DLco determine a worse clinical and physiological presentation. The present findings gives value to the determination of DLco in smokers without airway obstruction.

Background: Proper education on inhaler usage and COPD management is essential in managing COPD patients but it is not performed well at private clinics in Korea. Therefore this study was conducted to see the effect of comprehensive education program including inhaler training and COPD management at private clinics. Methods: We enlisted 286 patients with asthma or COPD on an outpatient basis at 40 private clinics in Korea. The patients were educated on inhaler usage and disease management three times on a two week basis. COPD assessment test (CAT) score was measured and questionnaires about correct usage of inhaler and understanding of COPD were obtained from physicians and patients before and after this education program. Outcomes of 127 patients with COPD (male : 89%, mean age : 67.8 ± 14.2 years) were analyzed. Results: CAT score (19.6 ± 12.5 vs. 15.1± 12.3) and COPD symptoms including cough, sputum, dyspnea, and chest tightness improved significantly after this education program (p Conclusion: Comprehensive education program including inhaler training and COPD management performed at private clinics improved CAT score, and led to patients9 better understanding of COPD management.

Background: The majority of developed prediction models for future exacerbations included smoking patients with COPD, but they may be not representative for non-smoking COPD patients. Aim: To develop criteria for assessing risk of frequent exacerbations in non-smoking patients with COPD. Methods: Twenty eight inflammatory biomarkers in peripheral blood, including lymphocytes subpopulations, cytokines, chemokines, immunoglobulins, acute-phase proteins, and eight clinical parameters were quantified in 42 non-smokers with COPD. The validation cohort consisted of 20 non-smoking patients with COPD. We defined non-smokers as subjects who smoked less than 100 cigarettes in their lifetime. Frequent exacerbations were determined as two or more exacerbations. Patients with infrequent exacerbations were defined as those who had no or one exacerbation in a year. Logistic regression analysis was used to develop the prediction model. Results: The final mathematical model to predict the frequency of exacerbations during 12 months after the examinationin non-smoking patients with COPD included three variables: CAT (COPD Assessment Test) score and plasma concentrations of vascular endothelial growth factor and C-reactive protein. The developed model had a sensitivity of 85.0%, specificity of 81.0%, accuracy of 82.9%, positive predictive value (PPV) of 81.0% and negative predictive value (NPV) of 85.0%.Sensitivity, specificity, accuracy, PPV and NPV of proposed model in the validation cohort were 83.3%, 78.6%, 80.0%, 62.5% and 91.7% respectively. Conclusion: The proposed model to assess the risk of future COPD exacerbations is robust and can be easily applied to individual non-smoking patients.

Background: COPD is characterized by persistent airflow limitation. FEV1 and FVC are not good predictors of exercise tolerance, dyspnea and quality of life. The GOLD 2011 document proposed a new classification system for COPD combining symptom, exacerbation risk and Lung function. For assessing symptoms, GOLD 2011 recommends the use of the Modified Medical Research Council (mMRC) scale or the COPD Assessment Test (CAT). The aim of our study is whether the assignment of a patient in a group could change depending on the symptom scale that is used. Material and method: observational prospective cohort study of subjects with COPD. Inclusion Criteria: FEV1/FVC post-BD: 10 packs/years. We categorize patients into: A: low risk, less symptoms; B: low risk, more symptoms; C: high risk, less symptoms; D: high risk, more symptoms. Subjects were classified twice according to CAT questionnaire and mMRC scale. Results: We included 42 subjects with a mean age of 67 years, 71.4% were men. The mean FEV1 was 65 and mean IMC was 28. The mean packs/years was 54.14 and twenty three subjects (54.8) were former smokers. Twenty seven subjects (64%) were low risk according to GOLD criteria (lung function, number of exacerbations and hospitalizations). By using mMRC scale, 24 (57.1%) subjects were assigned to group A, 3 (7.1%) to group B, 7 (16.7%) to group C, and 8 (79%) to group D. By using CAT score, 16 (38.1%) patients were assigned to group A, 11 (26.2%) to group B, 6 (14.3%) to group C, and 9(21%) to group D. Conclusions: Our study suggests the fact of using mMRC scale or CAT scores, may influence the treatment and classification of our patients according to GOLD guidelines.

Background: CAT (COPD Assessment Test) is a validated 8-item questionnaire designed to evaluate symptoms in COPD patients. Our study aimed to evaluate COPD symptoms as a marker for mortality, measured in total CAT-score as well as individual symptom scores. Methods: We included 285 patients with an established COPD diagnosis, admitted with COPD-exacerbation to several hospitals in Western Norway, using data from the Norwegian COPD Registry. All patients completed a CAT questionnaire before discharge, in addition, the patients performed a spirometry, arterial blood gas sampling, and had their BMI and co-morbidities evaluated. The patients were followed for up to 5 years. Mortality was evaluated using cox-regression, adjusting for sex, age, FEV1, BMI and blood gas analysis (hyperkapnia). Results: 118 of 285 patients died within follow up. Median CAT score at discharge was 24 of maximum 40 points. Increasing CAT score was significantly associated with higher mortality, HR 1.02 (1.01-1.04, p Conclusion: Increasing CAT score is associated with higher mortality, however, simply asking about breathlessness at stair walking or domestic activity limitations may give a better indication of mortality risk.

Background: The COPD assessment test (CAT) is widely used for basic symptom evaluation in patients with COPD. The impact of COPD phenotypes on symptom scores using the CAT, however, remains largely unknown. Methods: The POPE-Study (NCT02119494) is an international, multicentre, observational cross-sectional survey of consecutive patients with COPD in Central and Eastern Europe (CEE). Respiratory symptoms using the modified Medical Research Council (mMRC) dyspnoea scale, and the CAT were recorded. Inclusion criteria: age ≥ 40 years, smoking history ≥ 10 pack-years, post-bronchodilator (BD) FEV1/FVC Results: 3366 COPD subjects (66 ± 8.8 yrs, post-BD FEV1 52.8 ± 18.5 % predicted, CAT 17.4 ± 7.8) were recruited. On the whole 63.3 % were non-exacerbators (NON-AE), 20.4 % frequent exacerbators with chronic bronchitis (AE CB), 9.5 % frequent exacerbators without CB (AE NON-CB), and 6.9 % were patients with asthma-COPD overlap syndrome (ACOS). There were apparent statistically significant differences ( Conclusion: There were noted significant differences in total CAT and individual CAT items between clinical phenotypes of COPD.

BACKGROUND: Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is defined by change of the symptoms. The establishment of a standardized method to quantify and evaluate the symptoms is expected. STUDY OBJECTIVE: We investigated and compared the responsiveness of the Exacerbations of Chronic Pulmonary Disease Tool (EXACT), the COPD Assessment Test (CAT), the St. George9s Respiratory Questionnaire (SGRQ), Dyspnea-12 and Hyland Scale (global scale) during the recovery phase from AECOPD. METHOD: We followed 28 patients who had been hospitalized because of AECOPD, and compared the scores of each PROs at the baseline with the scores obtained 14, 28, 56 and 84 days later. RESULTS: The EXACT total score (possible range; 0-100) improved from 50±12 to 32±14, CAT score (possible range; 0-40) from 24±9 to 13±8, the SGRQ score from 55±21 to 41±24, Dyspnea-12 score (possible range; 0-36) from 10±10 to 5±6, and Hyland Scale (possible range; 0-100) from 45±19 to 62±21 during the first 28 days. The effective size of the EXACT total and CAT score was -1.36 and -1.30 respectively, although the SGRQ, Dyspnea-12, and Hyland Scale were less responsive with the effect size of -0.52, -0.64, and 0.82. Therefore, the EXACT total score and CAT score showed best responsiveness. From the perspective of score distribution, only the EXACT total score showed normal distribution. CONCLUSION: The EXACT total score may be the ideal measure during the recovery phase from AECOPD.

Introduction Database studies suggest a steady intensification of COPD maintenance medication, with the majority of patients eventually receiving a LABA/LAMA/ICS combination. However, such studies include generally only data on medication use. Here, we analysed data from the ongoing, non-interventional, observational DACCORD study to determine whether there was a correlation between baseline GOLD 2011 category and change in medication use over 2 years. Methods This abstract presents data on medication use at baseline and at 1 and 2 years, by baseline GOLD 2011 category (A,B,C and D with symptoms evaluated using the COPD Assessment Test). Results 3315 patients with COPD have completed the 2 year follow-up (58.6% male, mean age 65.6 years) in 349 centres. The changes from baseline to Year 1, and from Year 1 to Year 2 in maintenance COPD medication use, by baseline GOLD 2011 category, are shown in Table 1. Conclusions Over the 2-year study period, there was a shift from monotherapy to dual bronchodilation (LABA/LAMA), but no important change in the proportion of patients on ICS-containing dual or triple regimens. The majority of shifts occurred in the first year. Baseline GOLD 2011 category did not appear to correlate with any shifts observed.

Aim: We examined 2 groups of elderly (≥65yrs) smokers (≥20p/y) with primary diagnosis of COPD and/or CHF to investigate prospectively the risk factors for hospitalization and death due to cardiopulmonary events over 3 yrs. Methods: In 144 COPD pts (68-77 yrs;male 76%) and 96 CHF pts (71-78 yrs;male 91%), we assessed age-adjusted Charlson Index (CCI), COPD Assessment Test (CAT), modified Medical Research Council (mMRC) dyspnea scale, spirometry, and echocardiography. Results: COPD pts were in GOLD classes I(32), II(79), III(30), IV(3), whereas CHF in NYHA classes I(40), II(49), III(6), missing in 1 patient. Among CHF pts, 26% had airflow limitation (mostly with moderate obstructive ventilatory pattern). The prevalence of CHF in COPD pts was 5% (mainly NYHA class I). CCI score was greater in CHF as compared to COPD pts (p Conclusions: Older age, comorbidities and dyspnea are major risk factors for hospitalization and death due to cardiopulmonary causes in smokers with COPD and/or CHF. Lower lung function predicts only the future risk of hospital admission in these patients. Funded by Ministry of Health, CFR, Chiesi Foundation

Background: The GOLD strategy proposes a COPD assessment framework based on symptoms and exacerbation risk;this study was conducted in Japanese patients with moderate-to-severe COPD using a protocol based upon monthly symptom assessment and occurrence of exacerbations (Betsuyaku et al Int J COPD 2013;8:453). Aims: To compare rate of physician-diagnosed COPD exacerbations (reported events) with unreported events identified using the Exacerbations of Chronic Pulmonary Disease Tool (EXACT). Methods: Patients were randomized to receive 24 weeks treatment with either salmeterol/fluticasone propionate 50/250μg BID or tiotropium 18μg QD and assessed every 4-weeks. Physician9s diagnosis of COPD exacerbations was made independently of any events recorded in the EXACT diary. Event rates were calculated using a negative binomial regression. Results: 406 patients participated; mean FEV 1 %predicted 59±13% and COPD assessment test score 12±6 at baseline. Three hundred sixty six subjects (90.1%) completed. Kaplan-Meier plots for time to first event between reported and unreported events showed differences in cumulative onset; EXACT detected 288 events (175subjects; 1.79/person-year 95%CI: 1.56-2.05), whereas physicians reported56 events (49subjects; 0.33/person-year; 95%CI: 0.24-0.44) - a 5.5 fold difference (post-hoc analysis). Six subjects with reported events were admitted to hospital. Conclusion: COPD exacerbations are reported to be relatively infrequent in Japanese patients (Suzuki et al ERJ 2013; 43:1289); this study suggests that under-reporting by patients or under-recognition by physicians may be factors contributing to this low rate. Funding: GSK (NCT01762800).

Anxiety and depression are common comorbidities in patients with chronic obstructive pulmonary disease (COPD) and affect patients’ health status [1, 2]. Health status in COPD patients is frequently assessed by the St George’s Respiratory Questionnaire (SGRQ), which is a validated disease-specific questionnaire widely used in clinical trials [3], but complex and time-consuming to complete and score. Consequently, the COPD Assessment Test (CAT) has been developed [4]. This is a disease-specific health status questionnaire containing eight items with good sensitivity, reliability and responsiveness [4]. CAT scores are strongly positively correlated with SGRQ scores in patients with COPD [4]. Therefore, it is reasonable to hypothesise that those COPD patients with symptoms of anxiety and/or depression will report higher CAT scores (equalling worse health status) compared to those without symptoms. The latest version of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) document [5] recommends the CAT as a tool to assess the impact of COPD on the individual patient beyond airflow limitation. Although it was known that clinically relevant symptoms of anxiety and depression are more common in patients in GOLD stage IV compared to patients in GOLD stages I and II [1], the frequency distribution of patients with symptoms of anxiety and depression across the updated GOLD classification remains unknown. Recently, Sillen et al. [6] reported a prevalence of symptoms of anxiety and depression of 38% and 32%, respectively, in COPD patients with GOLD group D. We aimed to assess …

Background: Chronic Obstructive Pulmonary Disease (COPD) progression increases dyspnea in activities of daily living, thereby worsening the impact of disease and decreasing quality of life. The combined training is the most complete physiologically resource, being able to improve these variables. Aim: To verify the responsiveness of dyspnea, impact of COPD on health status and quality of life on aerobic and resistance training in different intensities. Methods: Twenty-three COPD patients were assessed and reassessed by: modified Medical Research Council (mMRC), London Chest Activity of Daily Living (LCADL), COPD Assessment Test (CAT) and Saint George Respiratory Questionnaire (SGRQ). The patients were randomized into two groups and performed 36 training sessions: Aerobic + High Intensity Resistance Training (HIRT: n=11, 68.8±6.6yrs; FEV 1 =47.7±16.2%pred) and Aerobic + Low Intensity Resistance Training (LIRT: n=12, 68.3±10.5yrs, FEV 1 =52.8±18.2%pred). Results: There were significant reductions (p≤0.05) in mMRC (from 2[1-3] to 1[1-2]) and LCADL (from 16[14-17] to 13[12-14]) in HIRT group. In LIRT group, only CAT (from 15.3±10.5 to 11.3±9.1) and SGRQ activities domain (from 46±25.3 to 28.8±22.2) presented significant difference. Moreover, there was a minimal important difference in SGRQ (>4) and CAT (>1.6) in both groups and mMRC (≥1) only in HIRT, with no significant differences between changes post training. Conclusion: COPD patients showed similarly responsiveness to impact of COPD and quality of life for both intensities of training, but those undergoing HIRT showed also significant improvement for dyspnea in daily activities.

Rationale: The QUANTIFY study compared the approved dual bronchodilator QVA149 with the free-dose combination of tiotropium plus formoterol (TIO+FOR) regarding lung function, dyspnoea and health status in patients with moderate-to-severe COPD. This post-hoc analysis reported on the subgroup of pts without ICS background therapy. Methods: This blinded, triple-dummy 26-week study randomised patients to QVA149 110/50 µg OD or TIO 18 µg OD plus FOR 12 µg b.i.d. (1:1). ICS was allowed as background therapy. Endpoints included lung function (trough FEV1), dyspnoea (TDI) and health status (COPD Assessment Test, CAT). Results: Of the 934 pts randomised (QVA149 [N=476] or TIO+FOR [N=458]); 87.9% completed the study. 41% of all pts had ICS background therapy, but only 2.6% of those were frequent exacerbators. The subgroup of patients without ICS, representing 59% of all pts (QVA 149 [N=275], TIO+FOR [N=274]), showed a statistically significant improvement in breathlessness (least square mean difference (LSMD) in TDI: 0.66; 95% CI: 0.08-1.24 p=0.027), lung function (LSMD trough FEV1: 77 mL, 95% CI: 33-120 mL, p Conclusion: QVA149 showed significant improvements in dyspnoea, health status and lung function in the subgroup of patients without ICS use compared with TIO+FOR free-dose combination.

Background: The COPD assessment test(CAT),a patient-filled questionnaire,is recommended as part of the assessment of COPD patients.CAT scores in non-COPD population(normative values)have not been studied in Indian population. Aim: To determine normative values and psychometric properties of CAT questionnaire Methods: Between Dec 2014-Feb 2015,consecutive subjects undergoing spirometry as part of an annual health screening at P.D.Hinduja Hospital,Mumbai were enrolled to fill up CAT questionnaires.Among non-COPD subjects(postbronchodilator FEV1/FVC≥0.7),normative values and psychometric properties of the test were characterized. Results: Of 183 subjects undergoing health check-up,161 non-COPD subjects were included.Mean FEV1/FVC ratio was 0.80(SD 0.48);mean predicted FEV1 was 98.6%(SD 15.2).Overall mean CAT score was 9.26(SD 6.38);lower in females(9.06,SD 5.58)and higher in subjects>60 years of age(mean 11.13,SD 7.67).Cronbach alpha for CAT was 0.81,suggesting high internal consistency.Determinants of subjects(39%)having CAT score≥10 compared to those

Background: Pulmonary rehabilitation (PR) is a baseline-therapy in patients with COPD without effects on forced expiratory volume in 1 second (FEV 1 ). So far, COPD GOLD I-IV used FEV 1 , CAT-Score allows an extended graduation in grade A-D. Aims and objectives: The aim was to find out whether the outpatient PR has an effect on CAT and the new GOLD classification. Methods: 187 COPD patients attended an outpatient PR program: in phase II (P2) 60 units a 50 minutes for 6 weeks and in phase III (P3) 45, 67.5 or 90 units for 6-12 months. CAT and performance parameters were measured before and after PR. Restults: Overall, CAT improves from 15.00 (min=3; max=34) to 10.00 (min=1; max=32) significantly. With a MCID defined as -2, the difference of -3.00 is of clinical relevance. In both, P2 (16.00 (min=5; max=34) to 11.00 (min=1; max=30)) and P3 (14.00 (min=3; max=29) to 10.00 (min=3; max=32)), significant changes were detected (p=0.000). Moreover, in COPD II-IV (COPD II from 13.94±7.07 to 10.34±6.38,p Conclusions: Outpatient PR leads to significant and clinically relevant changes in CAT reducing symptoms and in improvements of GOLD classification, which may result in reduction of medication. Further prospective studies could prove these data.

Background: For COPD patients, influence of disease on quality of life is measured via questionnaires. In this study, the goal was to evaluate the validity and reliability of the short and easily translated COPD Assessment Test (CAT), Persian translation. Materials and Methods: This was a cross sectional pilot study with completion of the Persian translation of the CAT questionnaire by COPD patients attending the emergency room Masih Daneshvari Hospital during the time period between winter of 2012 and summer of 2012. The results of the questionnaire were compared with the Saint George Respiratory Questionnaire, number of respiratory medications and frequency of visits to the emergency room. Results: In total, 32 patients participated in this study with mean age of 60±13years and 98% of the patients were men and 7% were women. The Cronbach9s alpha coefficient for the CAT questionnaire was calculated to be 0.732. There was statistically significant correlation between the scores from the CAT questionnaire and the total scores from the SGRQ (Pearson correlation coefficient=0.590, P=0.010). Discussion: This pilot study showed that the CAT questionnaire was well accepted by the patients with almost all questions being answered. The reliability of the questionnaire using Cronbach9s alpha coefficient was acceptable and the questionnaire score correlated with the total score on the SGRQ questionnaire.