How to Take a COPD Assessment Test (CAT)
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Simple, Self-Evaluation Can Tell You a Lot About Your Condition
By Lauren Van Scoy, MD
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There are a number of questionnaires that doctors use to assess the severity and impact of chronic obstructive pulmonary disease (COPD). One of them is called the COPD assessment test, also known as the CAT. It is comprised of eight question by which patients rate both their symptoms and the relative level of impairment.
Why the CAT Is Important
The year 2011 was characterized by a sea change in how COPD was approached. It was then that the scientific committee of the Global Initiative for Obstructive Lung Disease (GOLD) issued recommendations stating that COPD should no longer be treated based solely on diagnostic tests like spirometry. The GOLD committee recognized that these tests, while valuable, had shortcomings in their ability to assess what a person was experiencing.
In some cases, for example, a person with COPD may be diagnosed with minor impairment and be unable to walk up a flight of stairs. By contrast, a person with moderate impairment may function more normally than the diagnostic tests suggest.
The updated guidelines acknowledged that the expression of COPD is based on many intersecting factors, including the restriction of respiratory function, the frequency of exacerbations, and the person's own perception of his or her illness.
How the CAT Works
The CAT is at once simple and highly descriptive. The eight questions are each rated on a scale of 0 to 5. The numbers are then tallied for a score of 0 to 40. The higher the number, the more serious the impairment. The range of questions is related to different aspects of the disease, as follows:
Cough - rated from 0 for "I never cough" to 5 for "I cough all the time"
Mucus - rated from 0 for "I have no mucus at all" to 5 for "My chest is completely full of mucus"
Chest tightness - rated from 0 for "My chest does not feel tight at all" to 5 for "My chest feels very tight"
Shortness of breath - rated from 0 for "When I walk up one flight of stairs, I am not breathless" to 5 for "When I walk up one flight of stairs I am very breathless"
Activity restriction at home - rated from 0 for "I am not limited doing any activities at home" to 5 for "I am very limited doing activities at home"
Activity restriction outside of the home - rated from 0 for "I am confident leaving my home despite my lung condition" to 5 for "I am not at all confident leaving my home because of my lung condition"
Impact on sleep - rated from 0 for "I sleep soundly" to 5 for "I don't sleep soundly because of my lung condition"
Impact on energy - rated from 0 for "I have lots of energy" to 5 for "I have no energy at all"
What the Results Tell Us
While the CAT is not used to diagnose COPD, it is valuable in determining when treatment should be started, how many treatments should be prescribed, and how well or poorly a person is responding to the treatment.
Based on the GOLD guidelines, persons with scores higher than 10 should receive daily therapy as soon as possible. Moreover, any increase of more than two—either up or down—is considered a significant change in symptom control. Any upward trend is considered a deterioration while a downward trend is considered an improvement.
While not all clinicians have adopted the CAT in their daily practice, some studies have suggested that it may be useful in predicting the risk of exacerbations, the development of depression, and progression of symptomatic disease.
Karloh, M.; Mayer, A.; Maurici, R. et al. "The COPD Assessment Test: What Do We Know So Far?" Chest J. 2016; 149(2):413-25. DOI: 10.1378/chest.15-1752.
Rodriguez-Roisin, R.; Rabe, K.; Vestbo, J. et al. "Global Initiative for Chronic Obstructive Lung Disease (GOLD) 20th Anniversary: a brief history of time." Int Resp J. 2017; 50:1700671. DOI: 10.1183/13993003.00671-2017.
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