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Open Access Highly Accessed Research article

Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ)

Ioanna G Tsiligianni123*, Thys van der Molen23, Despoina Moraitaki1, Ilaine Lopez23, Janwillem WH Kocks23, Konstantinos Karagiannis1, Nikolaos Siafakas1 and Nikolaos Tzanakis1

Author Affiliations

1 Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Crete, P.O 71003, Greece

2 Department of General Practice, University Medical Centre Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands

3 GRIAC research institute, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, P.O 9700 AD, Groningen, The Netherlands

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BMC Pulmonary Medicine 2012, 12:20  doi:10.1186/1471-2466-12-20

Published: 20 May 2012

Abstract

Background

Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ).

Methods

We administered the CAT, CCQ and SGRQ in patients with COPD stage I-IV during three visits. Spirometry, 6 MWT, MRC scale, BODE index, and patients perspectives on questionnaires were recorded in all visits. Standard Error of Measurement (SEM) was used to calculate the Minimal Clinical Important Difference (MCID) of all questionnaires.

Results

We enrolled 90 COPD patients. Cronbach's alpha for both CAT and CCQ was high (0.86 and 0.89, respectively). Patients with severe COPD reported worse health status compared to milder subgroups. CAT and CCQ correlated significantly (rho =0.64, p < 0.01) and both with the SGRQ (rho = 0.65; CAT and rho = 0.77; CCQ, p < 0.01). Both questionnaires exhibited a weak correlation with lung function (rho = −0.35;CAT and rho = −0.41; CCQ, p < 0.01). Their reproducibility was high; CAT: ICC = 0.94 (CI 0.92-0.96), total CCQ ICC = 0.95 (0.92-0.96) and SGRQ = 0.97 (CI 0.95-0.98). The MCID calculated using the SEM method showed results similar to previous studies of 3.76 for the CAT, 0.41 for the CCQ and 4.84 for SGRQ. Patients suggested both CAT and CCQ as easier tools than SGRQ in terms of complexity and time considerations. More than half of patients preferred CCQ instead of CAT.

Conclusions

The CAT and CCQ have similar psychometric properties with a slight advantage for CCQ based mainly on patients’ preference and are both valid and reliable questionnaires to assess health status in COPD patients.

Keywords:
Health status; COPD Assessment Test (CAT); Clinical COPD Questionnaire (CCQ)