Depressive status explains a significant amount of the variance in COPD assessment test (CAT) scores

Abstract

Background

COPD assessment test (CAT) is a short, easy-to-complete health status tool that has been incorporated into the multidimensional assessment of COPD in order to guide therapy; therefore, it is important to understand the factors determining CAT scores.

Methods

This is a post hoc analysis of a cross-sectional, observational study conducted in respiratory medicine departments and primary care centers in Spain with the aim of identifying the factors determining CAT scores, focusing particularly on the cognitive status measured by the Mini-Mental State Examination (MMSE) and levels of depression measured by the short Beck Depression Inventory (BDI).

Results

A total of 684 COPD patients were analyzed; 84.1% were men, the mean age of patients was 68.7 years, and the mean forced expiratory volume in 1 second (%) was 55.1%. Mean CAT score was 21.8. CAT scores correlated with the MMSE score (Pearson’s coefficient r=−0.371) and the BDI (r=0.620), both p<0.001. In the multivariate analysis, the usual COPD severity variables (age, dyspnea, lung function, and comorbidity) together with MMSE and BDI scores were significantly associated with CAT scores and explained 45% of the variability. However, a model including only MMSE and BDI scores explained up to 40% and BDI alone explained 38% of the CAT variance.

Conclusion

CAT scores are associated with clinical variables of severity of COPD. However, cognitive status and, in particular, the level of depression explain a larger percentage of the variance in the CAT scores than the usual COPD clinical severity variables.

Keywords:

• COPD
• CAT
• Mini-Mental State Examination
• MMSE
• Beck Depression Inventory
• BDI

Acknowledgments

The DEPREPOC study has been funded by Grupo Ferrer (Barcelona, Spain). The authors would like to acknowledge the role of Saned (Barcelona, Spain) in monitoring of the study and statistical analysis of data, and the participation of the following investigators in the DEPREPOC study: Ada Luz Andreu, Adolfo García Molné, Ahmad Khalaf Ayash, Alberto Saura Vinuesa, Alejandra Marín Arguedas, Alejandro García Huete, Alejandro Muñoz Fernández, Alfons Torrego Fernández, Alfonso Van Der Eynde Collado, Alfredo González Panizo, Alfredo Pérez Cortada, Alicia Catalán Salelles, Alicia Marín Tapia, Alicia Taboada Duro, Alvaro Ortega Gutierrez, Alvaro Pérez Gómez, Amin Shubbi Shehebar, Amparo Alaban Ibáñez, Ana Boldova Loscertales, Ana Fortuna Gutierrez, Ana Luisa Kersul, Andrés Huete Martos, Andres Sánchez Barón, Angel Lara Font, Angels Puigdollers Rovellat, Antoni Riba Blanch, Antonio Bosquet Álamo, Antonio Camps Selles, Antonio Cuesta Sánchez, Antonio Hernández Ruiz, Antonio Pablo Arenas Vacas, Antonio Rodríguez Celaya, Antonio Tafalla Martín, Antonio Torras Picón, Armand Izquierdo Martínez, Bassam Darwich Muhti, Benigno Del Busto De Lorenzo, Berta Avilés Huertos, Carlos A Aguado Hernández, Carlos Martín Carrasco, Carlos Martínez Rivera, Carlos Millan Sánchez, Carme Santiveri Gilabert, Carmen Soto Fernández, Casimir Money Sánchez, Ceferino Pico López, Celedonio Sobera Echezarreta, Cesar Vidal González, Cesáreo López Rodríguez, Claudio Vidal De Mesa, Concepción Pérez Domínguez, Concepción Plans Bolibar, Concepción Rodríguez Fernández, Dámaso Escribano Sevillamo, David Blanques Escribano, David Herrero I Barrera, David Orts Giménez, Demetrio González Vergara, Deopatria Esteban Fresno, Diego Ferrer Marín-Blazquez, Domingo Fernández García, Eloy López Neira, Emilio Viudes Plazas, Encarnación Fernández Robledo, Enrique Alvarez-Llaneza García, Enrique José Pérez Parra, Enrique López De Briñas Y Banacloy, Enrique Sardaña Álvarez, Erika Tavera Gómez, Esperanza Martín Zapatero, Faustino Vega Pérez, Felipe Nicolau Pastríe, Félix Martín Santos, Fernando De Arriba Frade, Fernando Dolz Andrés, Fernando L Sancho Villanova, Fernando Marco Cardona, Fernando Martí-Vivaldi Martínez, Fernando Mayo Ferreiro, Fernando Sánchez-Toril López, Francisco De Pablo Cillero, Francisco Durán Hernández, Francisco Javier Balda Jau-regui, Francisco Javier Bartolomé Resano, Francisco Javier Fernández De Frutos, Francisco Javier Guerra Ramos, Francisco Javier Rodríguez Argüeso, Francisco Javier Tamayo Sicilia, Francisco Luis Gil Muñoz, Francisco Manuel Balaguer Montesinos, Francisco Martos Torres, Francisco Risco Sánchez, Francisco Samuel Fernández Escribano, Francisco Sangenis Biosca, Francisco Vaques Arias, Froilan Sáncez Sánchez, Gador Ramos Villalobos, Gemma Martínez Almagro, Gerardo Estruch Catalá, Germán Fernández López, German Saez Roca, Gonzalo Carles Hueso, Guadalupe Fernández Esteve, Guillermo Pérez Toledo, Gustavo Solince Gallardo, Hugo Dante García Ibarra, Ignacio Abascal Carey, Ignacio J Pérez De Diego, Inés Gil Gil, Irene De Lorenzo García, Isabel Lledó Fillol, Isidro Rodoreda Meillán, Jaime Creixell Sánchez, Javier Amiama Ruiz, Javier Antón Ortega, Javier Gallego Borrego, Javier Gallego Borrego, Jesús Armando Montero Abramonte, Jesús Castillo Ballesteros, Jesús Chamorro Romero, Jesús De La Fuente Pérez, Jesús Pastor Antón, Jesús Picazo Moreno, Jesús Zumeta Fustero, Joan Carle Caballero Dome-nech, Joan Clotet Solsona, Joan Cornet Sisquella, Joan Juvanteny Gorgals, Joan Ribot Pérez, Joan Ventosa Rodón, Joaquín Ferrandiz Miquel, Joaquín Salazar Vargas, Jorge Jorge Abad Capa, Pascual Bernabeu, José Antonio Carratalá Torregrosa, José Antonio Gómez Marco, José Antonio Martín Bernal, José Antonio Martín Soledad, José Berrocal Del Rio, José Burillo Arias, José Celdrán Gil, José Enrique Gavela García, José Enrique Lezcano Devesa, Jose Ignacio González Castellano, José Luis Colomer Martí, José Luis Del Rio Pedrosa, José Luis Fernández Menéndez, José Luis Rojas Box, José Maldonado Díaz De Losada, José Manuel Bretones Rodríguez, José Manuel Lorente Iniesta, José Manuel Muñoz Malagarriga, José María Esteve Ribelles, José María Jiménez Páez, José María Sánchez Mariscal, José Mario Salabert Rius, José Miguel Durán Durán, José Miguel Durán Durán, José Miguel Grima Barbero, José Pruñonosa Piera, José Sánchez Aldeguer, José Sanz Santos, José Vicente Campos Cristobal, Josep Comerma Barcelo, Josep María Alsina Martín, Josep María Benet Martí, Josep Maria Cuatrecasas Ardid, Josep María Jové Ysanta, Juan Abreu González, Juan Antonio Chavez Plasencia, Juan Antonio Lloret Queraltó, Juan Antonio Martínez Carbonell, Juan Antonio Royo Prats, Juan Antonio Sánchez Palau, Juan B Navarro González, Juan Barón Carrillo, Juan Carles Clara Riart, Juan Carlos Martín La Foz, Juan Enrique Luces Macias, Juan Francisco Andrade Bellido, Juan Francisco De Vega García, Juan Gil Carbonell, Juan Guallar Ballester, Juan Guijo Castro, Juan Hilanderas Jiménez, Juan Jiménez Guillén, Juan José Linares Linares, Juan José Martínez De La Torre, Juan Luis De La Torre Alvaro, Juan Luis García Rivero, Juan Manuel Acosta Méndez, Juan Manuel Meseguer Gil, Juan Manuel Nieto Somoza, Juan Manuel Verdeguer Miralles, Juan Miguel Sampol Company, Juan Ortiz De Saracho Y Boho, Juan Pablo García Muñoz, Juan Ramis Alemany, Juan Suárez Antelo, Juan Viles Valentí, Julia Vazquez Vazquez, Julián Ramón Garrido Jiménez, Julio Antonio García Cañizares, Julio Aurelio Gorriz Nuñez, Julio Portela Carreiro, Justo Grau Delgado, Khaled A Bdeir Egnyem, Larraitz Garcia Echeberria, Lirios Sacristán Bou, Lorenzo Jiménez Alfonso, Lucia Díaz Cañaveral, Lucia Díaz Cañaveral, Luis Antonio González Rodriguez, Luis Camara Cabrerizo, Luis Carlos Aguilar Martínez, Luis Emilio Del-gado Torices, Luis M Entrenas Costa, Luis Rodríguez Pas-cual, Luis Toca Enrique, Luisa Valladares Rodríguez, Maite Andreu Sabdell, Maite Gómara Urdiain, Manuel Carlos Barreiro Mourentan, Manuel Castilla Martínez, Manuel Cervera Del Pino, Manuel Mª Liñares Stolle, Manuel Mar-tínez Riaza, Manuel Miquel Palasi, Manuel Ocaña Torres, Manuel Pastor Rull, Manuel Salcedo Espinosa, Manuel Tor-res Pascual, Manuel Vicente Chincilla, Manuel Vila Justribó, Manuel Vila Justribó, Marc Bonnin Vilapalan, María Begoña Salinas Lasa, María Belén Alonso Ortiz, María Del Carmen Victoria López, Maria Del Pilar Ortega Castillo, María Dolores Gallardo García, María Dolores Mota Godoy, María Eugenia Casado López, María Isabel Parra Parra, María Jesús Avilés Inglés, María José Pericón Puyal, María Lucia Gascón Pedrola, Maria Luisa Moreno Tores, María Luisa Rivera Ortun, María Martínez Ceres, María Rosa Calderer Cardona, Mariano Muñoz Llanez, Marina C Rodríguez Hernández, Marta Palop Cervera, Miguel A Martín Pérez, Miguel Ángel Ciscar Vilanova, Miguel Angel García González, Miguel Angél López Aranda Miguel Angel Palomino Medina, Mireia Vila Santiago, Mishail Dahdouh Kuri, Mónica Cañero Torrecillas, Monserrat Llop Moreno, Monserrat Llordes Llordes, Narciso Fernández Carbajo, Natalia Carretero Suero, Nestor Almeida Pérez, Nur El-Homssi Jarsa, Nuria Castejón Pina, Pascual Llop Usó, Pascual Mañes Vicente, Patricia Lloberes Canadell, Patricia Mata Calderón, Pau Llacér Iborra, Pedro Penela Penela, Pedro Baños Hidalgo, Pedro J Romero Palacios, Pedro José De La Paz Gutierre, Pedro José López Villalba, Pedro Martínez Brugada, Pedro Pinto González, Pedro Vicioso Ranz, Pilar Lázaro Gracia, Pilar Marín Martínez, Rafael Belenguer Prieto, Rafael Calvet Madrigal, Rafael Castrodeza Sanz, Rafael Giménez Dome-nech, Rafael Lama Rodríguez, Rafael Machín Ramírez, Rafael Matoses Marco, Rafael Saez Valls, Rafael V Lluch Mota, Ramón Magarolas Jordá, Ramón Manuel Hernández Sadurní, Ramón Martínez Bretones, Ramón Tarrés Gimferrer, Raquel Llera Guerra, Roberto Veiga Gallego, Rodrigo Abad Rodríguez, Rosa María López Lisbona, Rosa Maria Pérez Nava, Rosario Cortina Rodríguez, Rosario Vargas González, Rossana Satorre Tomás, Rubén Andújar Espinosa, Rubén Saurent Helman, Salvador Bertran Folqué, Salvador Ruso Pacheco, Santiago Carrizo Sierra, Santiago Otaduy Bengoa, Sebastiana Pérez Rodríguez, Sergio Campos Téllez, Sergio Gallego Piote, Sergio Salvadó Vives, Silvia Molina Aguileras, Sonia Martínez Sáez, Teresa López Sangil, Teresa Peña Miguel, Tomás Lloret Pérez, Valentin Atxotegui Iraolagoitia, Valentina Moggi Zafferani, Vicente Gallego Rodríguez, Vicente Gomar Andrés, Vicente José Roig Figueroa, Vicente López Escrivá, Vicente Penades Vaya, Vicente Poveda Gran, Victor Jiménez Castro, Victor Vera Campillo, Virginia Serrano Gutierrez, Xavier Alfaro Rodriguez, Xavier Arnal Marcé, Xavier Casals Reynals, Xavier Martínez Álvarez, Xavier Ureta I Boixadera, Xavier Vilá Giralte, Xavier Vila Reyner, and Yolanda Galea Colón.

Disclosure

Marc Miravitlles has received speaker fees from Boehringer Ingelheim, AstraZeneca, Chiesi, GlaxoSmithKline, Menarini, Teva, Grifols, and Novartis and consulting fees from Boehringer Ingelheim, GlaxoSmithKline, Gebro Pharma, CLS Behring, Cipla, MediImmune, Mereo Biopharma, Teva, Novartis, and Grifols. Carlos Roncero has received fees to give talks for Janssen-Cilag, Bristol-Myers Squibb, Ferrer-Brainfarma, Pfizer, Reckitt Benckiser, Lundbeck, Otsuka, Servier, Lilly, GSK, Rovi, and Adamed. He has received financial compensation for his participation as a member of the Janssen-Cilag, Lilly, and Shire boards and conducted the PROTEUS project, which was funded by a grant from Reckitt-Benckisert. Anna Campuzano and Joselín Pérez are full-time employees of Grupo Ferrer (Barcelona, Spain). José Antonio Quintano has received speaker fees from Almirall, Bayer, Boehringuer, Ferrer, GSK, Novartis, Menarini, and TEVA; consulting fees from Almirall, Boehringuer, Ferrer, Menarini, Novartis, Mundipharma; and registration support for medical congresses from Almirall, Pfizer, Gebro, GSK, Mundipharma, Novartis, and ROVI. Jesús Molina has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Mundifarma, and Pfizer and consulting fees from Boehringer Ingelheim, Gebro Pharma, Mundifarma, and GlaxoSmithKline. The authors report no other conflicts of interest in this work.

Author contributions

MM wrote the manuscript. All authors contributed toward the study design, planning and interpretation of data analysis, and critically revising the paper; they approved the final version to be published and agreed to be accountable for all aspects of the work.