title: Impact of cardiovascular comorbidities on COPD Assessment Test (CAT) and its responsiveness to pulmonary rehabilitation in patients with moderate to very severe COPD: protocol of the Chance study.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Patients with COPD are characterised by a reduced health status, which can be easily assessed by the COPD Assessment Test (CAT). Previous studies show that health status can be worsened by the presence of comorbidities. However, the impact of cardiovascular comorbidities on health status as assessed with CAT is not sufficiently investigated. Therefore, the current study has the following objectives: (1) to study the clinical, (patho)physiological and psychosocial determinants of the CAT, and impact of previously established and/or newly diagnosed cardiovascular comorbidities on health status in tertiary care patients with COPD; (2) to assess the effects of pulmonary rehabilitation on CAT scores in patients with COPD; (3) to develop reference values for the CAT in Dutch elderly patients without COPD; and (4) to validate the CAT in a broad sample of Dutch patients with COPD.
  
  
  METHODS
  The COPD, Health status and Comorbidities (Chance) study is a monocentre study consisting of an observational cross-sectional part and a longitudinal part. Demographic and clinical characteristics will be assessed in primary care, secondary care and tertiary care patients with COPD, and in patients without COPD. To assess health status, the CAT, Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ) will be used. The longitudinal part consists of a comprehensive pulmonary rehabilitation programme in 500 tertiary care patients. For the cross-sectional part of the study, 150 patients without COPD, 100 primary care patients and 100 secondary care patients will be assessed during a single home visit.
  
  
  BACKGROUND
  The Medical Ethical Committee of the Maastricht University Medical Centre+ (MUMC+), Maastricht, the Netherlands (METC 11-3-070), has approved this study. The study has been registered at the Dutch Trial Register (NTR 3416).
authors.affiliation: Department of Research & Education, CIRO, Horn, The Netherlands.
authors.forename: Dionne E
authors.initials: DE
authors.lastname: Smid
authors.affiliation: Department of Research & Education, CIRO, Horn, The Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Wilke
authors.affiliation: Division of Clinical Science, St George's University of London, London, UK.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Jones
authors.affiliation: Department of Family Medicine, CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: Jean W M
authors.identifier: http://orcid.org/0000-0002-8780-476X
authors.initials: JW
authors.lastname: Muris
authors.affiliation: Department of Research & Education, CIRO, Horn, The Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: Department of Research & Education, CIRO, Horn, The Netherlands Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Frits M E
authors.initials: FM
authors.lastname: Franssen
authors.affiliation: Department of Research & Education, CIRO, Horn, The Netherlands.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology / Q000534:rehabilitation*; D012138:Respiratory Therapy; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: COPD assessment test; Cardiovascular comorbidities; Chronic Obstructive Pulmonary Disease; Health status