Send to

Choose Destination
Respir Med. 2014 Apr;108(4):600-8. doi: 10.1016/j.rmed.2013.12.014. Epub 2014 Jan 6.

The COPD assessment test (CAT) assists prediction of COPD exacerbations in high-risk patients.

Author information

Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-2-dong, Songpa-gu, Seoul 138-736, Republic of Korea.
Department of Internal Medicine, Kaohsiung Medical University Hospital, School of Medicine, Kaohsiung Medical University, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan.
The Institute of Respiratory Diseases, The First Affiliated Hospital of China Medical University, No. 117, Nanjing Street (N), Shenyang 110001, Liaoning, China.
Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, No. 135, Nan-Hsiao Street, Changhua City, Changhua County 500, Taiwan.
Division of Respiratory and Critical Care Medicine, Kyung Hee University Hospital, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-702, Republic of Korea.
Asia Pacific Medical, GlaxoSmithKline, 150 Beach Road, #22-00 Gateway West, Singapore 189720, Singapore.
Division of Clinical Science, St George's University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.
Australian Respiratory and Sleep Medicine Institute, Flinders Medical Centre, Bedford Park, Adelaide, SA 5042, Australia. Electronic address:


We evaluated the predictive value of the COPD assessment test (CAT™) for exacerbation in the following six months or time to first exacerbation among COPD patients with previous exacerbations. COPD outpatients with a history of exacerbation from 19 hospitals completed the CAT questionnaire and spirometry over six months. Exacerbation events were prospectively collected using a structured questionnaire. The baseline CAT score categorised into four groups (0-9, 10-19, 20-29, and 30-40) showed strong prediction for time to first exacerbation and modest prediction for any exacerbation or moderate-severe exacerbation (AUC 0.83, 0.64, and 0.63 respectively). In multivariate analyses, the categorised CAT score independently predicted all three outcomes (p = 0.001 or p < 0.001). Compared with the lowest CAT score category, the higher categories were associated with significantly shorter time to first exacerbation and higher exacerbation risks. The corresponding adjusted median time was >24, 14, 9, and 5 weeks and the adjusted RR was 1.00, 1.30, 1.37, and 1.50 in the category of 0-9, 10-19, 20-29, and 30-40 respectively. Exacerbation history (≥2 vs. 1 event in the past year) was related to time to first exacerbation (adjusted HR 1.35; p = 0.023) and any exacerbation during the study period (adjusted RR 1.15; p = 0.016). The results of this study support the use of the CAT as a simple tool to assist in the identification of patients at increased risk of exacerbations. This could facilitate timely and cost-effective implementation of preventive interventions, and improve health resource allocation.



COPD assessment test; Chronic obstructive pulmonary disease; Exacerbation; Prediction

[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center