title: The chronic obstructive pulmonary disease assessment test improves the predictive value of previous exacerbations for poor outcomes in COPD.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) exacerbations have a negative impact on the quality of life of patients and the evolution of the disease. We have investigated the prognostic value of several health-related quality of life questionnaires to predict the appearance of a composite event (new ambulatory or emergency exacerbation, hospitalization, or death) over a 1-year follow-up.
  
  
  METHODS
  This was a multicenter, prospective, observational study. Patients completed four questionnaires after recovering from an exacerbation (COPD Assessment Test [CAT], a Clinical COPD Questionnaire [CCQ], COPD Severity Score [COPDSS], and Airways Questionnaire [AQ20]). Patients were followed-up until the appearance of the composite event or for 1 year, whichever came first.
  
  
  RESULTS
  A total of 497 patients were included in the study. The majority of them were men (89.7%), with a mean age of 68.7 (SD 9.2) years, and a forced expiratory volume in 1 second of 47.1% (SD 17.5%). A total of 303 (61%) patients experienced a composite event. Patients with an event had worse mean scores of all questionnaires at baseline compared to patients without event: CAT=12.5 vs 11.3 (P=0.028); CCQ=2.2 vs 1.9 (P=0.013); COPDSS=12.3 vs 10.9 (P=0.001); AQ20=8.3 vs 7.5 (P=0.048). In the multivariate analysis, only previous history of exacerbations and CAT score ≥13.5 were significant risk factors for the composite event. A CAT score ≥13.5 increased the predictive value of previous exacerbations with an area under the receiver operating characteristic curve of 0.864 (95% CI: 0.829-0.899; P=0.001).
  
  
  CONCLUSIONS
  The predictive value of previous exacerbations significantly increased only in one of the four trialled questionnaires, namely in the CAT questionnaire. However, previous history of exacerbations was the strongest predictor of the composite event.
authors.affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Marc
authors.initials: M
authors.lastname: Miravitlles
authors.affiliation: Pneumology Unit, Hospital de la Plana, Villareal, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: García-Sidro
authors.affiliation: Medical Department, Takeda Farmacéutica España S.A., Madrid, Spain.
authors.forename: Alonso
authors.initials: A
authors.lastname: Fernández-Nistal
authors.affiliation: Pneumology Department, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Buendía
authors.affiliation: Pneumology Department, Hospital Universitario Virgen de la Salud, Toledo, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Espinosa de Los Monteros
authors.affiliation: Pneumology Department, Hospital Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Esquinas
authors.affiliation: Centro de Salud "Francia", Fuenlabrada, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Molina
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: AQ20; CAT; CCQ; COPD; COPDSS; exacerbations