With great interest we read the article by Ringbaek T et al published in the February issue in COPD journal raising the important issue of health status measurements in COPD patients attending a pulmonary rehabilitation programme [Citation1].
There are, however, some issues that we would like to highlight. The CCQ has been mentioned by the authors to have a mean total score of 26.5 (6-51) while CAT 1.81 (0.2-3.4) units. This with the remark that that the CAT overall score is calculated from each item divided by 8[Citation1] and CCQ scores were calculated by adding them up (we assume so as this was not reported in the article). However the CCQ total calculation of scores range from 0-6 and of CAT from 0-40 points. The CCQ scores can easily be calculated by adding the individual answers up and dividing them by the number of items (10 for total score, 4 for the symptom domain, 4 for the functional domain and 2 for the mental state domain). It can also be calculated in an automatic way available on www.ccq.nl. CCQ results can be interpreted as: acceptable (CCQ < 1); acceptable for moderate disease (1 ≤ CCQ <2); instable-severe limited (2 ≤ CCQ < 3); very instable-very severe limited (CCQ ≥ 3). On the other hand CAT is calculated in a total score out of 40 by adding the answers on individual items up [Citation3]. Scores of 0-10, 11-20, 21-30 and 31-40 represent low, medium, high and very high impact level respectively [Citation3,4]. The value of CAT 0-10 corresponds therefore with CCQ < 1. CAT and CCQ have been constructed as easy and practical tools to be used in daily clinical practice [Citation2,3].
The need for assessing health status in primary and secondary care COPD patients is indeed essential. The recent GOLD document advocates the measurement of health status using the CAT questionnaire [Citation4]. The article of Ringbaek supports the viewpoint of a special workforce of the International Primary Care Respiratory Group (IPCRG) that reported CCQ as the better questionnaire to do so in primary care [Citation5]. Arguments of the IPCRG are the better responsiveness, the practicality (easy to administer), tested in practice and the available translations validated in other languages. The study of Ringbaek now shows that the CCQ is also more understandable for the real life patient. Therefore we suppose that the choice of the GOLD committee to advocate exclusively the CAT as the preferred tool is not based on evidence.
References
- Ringbaek T, Martinez G, Lange P. A Comparison of the Assessment of Quality of Life with CAT, CCQ, and SGRQ in COPD Patients Participating in Pulmonary Rehabilitation. COPD. 2012 Feb;9(1):12–5
- van der Molen T, Willemse BW, Schokker S, ten Hacken NH, Postma DS, Juniper EF. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes 2003;1:13.
- Jones PW, Harding G, Berry P, Wiklund I, Chen WH, Kline Leidy N. Development and first validation of the COPD Assessment Test. Eur Respir J 2009 Sep;34(3):648–54.
- From the Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011. Available from: http://www.goldcopd.org/.
- Cave AJ, Tsiligianni I, Chavannes N, Correia de Sousa J, Yaman H. IPCRG Users’ Guide to COPD “Wellness” Tools. International Primary Care Respiratory Group. 2010 September. http://www.theipcrg.org/resources/ipcrg_users_guide_to_copd_wellness_tools.pdf