The use of health status questionnaires in the management of chronic obstructive pulmonary disease patients in clinical practice

Abstract

Current guidelines recommend chronic obstructive pulmonary disease (COPD) management based on symptoms or health status assessment and lung function parameters. However, COPD is a complex and heterogeneous disease that needs an individualized approach for proper disease management. A structured consultation including health status assessment tools, such as the Clinical COPD Questionnaire and the COPD Assessment Test should improve the quality of the consultation, providing more information than symptoms alone. Both questionnaires are designed to provide the clinician information enabling a more personalized disease approach and subsequent management. Although both Clinical COPD Questionnaire and COPD Assessment Test have good discriminate properties, their use as prognostic markers of severity and their ability to modify disease management has not yet been fully established. New studies are needed to further determine their value on several disease outcomes.

Keywords::

• CAT
• CCQ
• COPD
• health status
• management
• questionnaires

Financial & competing interests disclosure form

IG Tsiligianni has received travel fees and reimbursement for presentations and advisory boards from Boehringer Ingelheim and Novartis. T van der Molen has received grants for research, travel fees, reimbursements and advisory boards from Astra Zeneca, GSK, Almirall, Mundipharma, Boehringer Ingelheim, Chiesi, Teva and Novartis. T van der Molen also developed the CCQ and holds the copyright. Z Diamant is a part-time employee of QPS, The Netherlands. JWH Kocks received an unrestricted research grant from GSK NL. GSK holds the CAT copyright. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Improve quality and efficiency of consultation by incorporating short health status questionnaires as Clinical COPD Questionnaire (CCQ) or COPD Assessment Test (CAT) in clinical practice.

• The best way to incorporate short health status questionnaires is by asking patients to complete them at home in advance of the consultation.

• Health status questionnaires give information about patient’s perceived burden of chronic obstructive pulmonary disease and by that will influence both the consultation and management plans.

• Health status questionnaires can be used both in the first diagnostic consultation and in follow-up consultations.

• These questionnaires actually promote personalized approach to disease (management).

• Measurement of health status includes more than measurement of dyspnea alone since the modified Medical Research Council questionnaire only measures function related to dyspnea and it is not valid to measure health status.

• To measure health status, Global initiative for chronic obstructive pulmonary disease guidelines recommend using either the CAT or the CCQ.

• Both CCQ and CAT are valid instruments available in more than 60 languages through internet (www.ccq.nl and www.catestonline.org/).

• CCQ has been validated for individual use.

• The CAT has eight questions referring to one-dimensional health status appraisal.

• The CCQ has 10 questions divided in three domains: symptoms, functional status and mental status related to breathing problems. It might potentially give more information than CAT during the consultation, especially regarding the depressive symptoms.

• CCQ division in three domains gives physicians the ability to change approach according to the domain that is impaired, that is, manage depression when the mental health domain is impaired.

Notes