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 Hansel, Eric A. Hoffman, Richard E. Kanner, Eric Kleerup, Jerry A. Krishnan, Stephen C. Lazarus, Nancy K. Leidy, Wanda O'NealFernando J. Martinez, Robert Paine, Stephen I. Rennard, Donald P. Tashkin, Prescott G. Woodruff, Meilan K. Han

Research output: Contribution to journalArticle

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 (k 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 followup 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.

Original languageEnglish (US)
Pages (from-to)636-642
Number of pages7
JournalAnnals of the American Thoracic Society
Volume14
Issue number5
DOIs
StatePublished - May 1 2017

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Chronic Obstructive Pulmonary Disease
Cohort Studies
Outcome Assessment (Health Care)
Lung
ROC Curve
Dyspnea
Spirometry
Acute Disease
Cough
Walking
Fatigue
Disease Progression
Primary Health Care
Sleep
Thorax
Anxiety
Quality of Life
Demography
Exercise
Depression

Keywords

  • Health status
  • Obstructive lung disease
  • Quality of life
  • Questionnaires
  • Symptoms

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine

Cite this

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

In: Annals of the American Thoracic Society, Vol. 14, No. 5, 01.05.2017, p. 636-642.

Research output: Contribution to journalArticle

Martinez, CH, Murray, S, Barr, RG, Bleecker, E, Bowler, RP, Christenson, SA, Comellas, AP, Cooper, CB, Couper, D, Criner, GJ, Curtis, JL, Dransfield, MT, Hansel, N, Hoffman, EA, Kanner, RE, Kleerup, E, Krishnan, JA, Lazarus, SC, Leidy, NK, O'Neal, W, Martinez, FJ, Paine, R, Rennard, SI, Tashkin, DP, Woodruff, PG & Han, MK 2017, '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', Annals of the American Thoracic Society, vol. 14, no. 5, pp. 636-642. https://doi.org/10.1513/AnnalsATS.201610-815OC
Martinez, Carlos H. ; Murray, Susan ; Barr, R. Graham ; Bleecker, Eugene ; Bowler, Russell P. ; Christenson, Stephanie A. ; Comellas, Alejandro P. ; Cooper, Christopher B. ; Couper, David ; Criner, Gerard J. ; Curtis, Jeffrey L. ; Dransfield, Mark T. ; Hansel, Nadia ; Hoffman, Eric A. ; Kanner, Richard E. ; Kleerup, Eric ; Krishnan, Jerry A. ; Lazarus, Stephen C. ; Leidy, Nancy K. ; O'Neal, Wanda ; Martinez, Fernando J. ; Paine, Robert ; Rennard, Stephen I. ; Tashkin, Donald P. ; Woodruff, Prescott G. ; Han, Meilan K. / 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. In: Annals of the American Thoracic Society. 2017 ; Vol. 14, No. 5. pp. 636-642.
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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 (k 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 followup 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.",
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author = "Martinez, {Carlos H.} and Susan Murray and Barr, {R. Graham} and Eugene Bleecker and Bowler, {Russell P.} and Christenson, {Stephanie A.} and Comellas, {Alejandro P.} and Cooper, {Christopher B.} and David Couper and Criner, {Gerard J.} and Curtis, {Jeffrey L.} and Dransfield, {Mark T.} and Nadia Hansel and Hoffman, {Eric A.} and Kanner, {Richard E.} and Eric Kleerup and Krishnan, {Jerry A.} and Lazarus, {Stephen C.} and Leidy, {Nancy K.} and Wanda O'Neal and Martinez, {Fernando J.} and Robert Paine and Rennard, {Stephen I.} and Tashkin, {Donald P.} and Woodruff, {Prescott G.} and Han, {Meilan K.}",
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TY - JOUR

T1 - 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

AU - Martinez, Carlos H.

AU - Murray, Susan

AU - Barr, R. Graham

AU - Bleecker, Eugene

AU - Bowler, Russell P.

AU - Christenson, Stephanie A.

AU - Comellas, Alejandro P.

AU - Cooper, Christopher B.

AU - Couper, David

AU - Criner, Gerard J.

AU - Curtis, Jeffrey L.

AU - Dransfield, Mark T.

AU - Hansel, Nadia

AU - Hoffman, Eric A.

AU - Kanner, Richard E.

AU - Kleerup, Eric

AU - Krishnan, Jerry A.

AU - Lazarus, Stephen C.

AU - Leidy, Nancy K.

AU - O'Neal, Wanda

AU - Martinez, Fernando J.

AU - Paine, Robert

AU - Rennard, Stephen I.

AU - Tashkin, Donald P.

AU - Woodruff, Prescott G.

AU - Han, Meilan K.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - 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 (k 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 followup 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.

AB - 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 (k 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 followup 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.

KW - Health status

KW - Obstructive lung disease

KW - Quality of life

KW - Questionnaires

KW - Symptoms

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