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Simple COPD score could help nurses predict exacerbation severity

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Nurses can use a simple, eight-question test to accurately measure and predict the severity of symptoms in patients with chronic obstructive pulmonary disease, according to UK researchers.

The COPD Assessment Test (CAT) consists of eight questions designed to assess symptoms such as coughing, phlegm, chest tightness and breathlessness. Patients score each symptom on a six-point scale.

Researchers from University College London assessed the test in 161 COPD patients, who completed the questionnaire while their condition was stable, during an exacerbation and also during recovery.

Frequent exacerbators – patients who experienced more than two exacerbations a year – recorded significantly higher CAT scores while stable than those who experienced less frequent exacerbations. Infrequent exacerbators recorded average baseline scores of 16.8 compared with 19.5 for frequent exacerbators.  

CAT scores also reflected the severity of exacerbation symptoms. For example, rises in CAT scores during exacerbation were significantly linked to falls in lung capacity, as measured by FEV1.

Lead author and UCL clinical research fellow Alex MacKay said: “Incorporating CAT scores into the assessment of COPD patients may provide a standardised, objective method for assessing symptom severity in ….clinical practice.”

He said the study also indicated that the test could be used in future by patients to help self manage their condition, allowing them to seek additional treatment as their symptoms worsened based on increases in routine CAT scores.

Jane Scullion, a respiratory consultant nurse at University Hospitals of Leicester NHS Trust, told Nursing Times the test was a useful tool for nurses to judge any changes in a patient’s condition.

She said: “It gives you a baseline – an idea of where the patient is at. It may be extremely useful for COPD services in the community who are trying to keep patients out of hospital.”

Ms Scullion, who is also a trustee of the Primary Care Respiratory Society, added: “Anything which helps us monitor changes in our patients and get early and prompt treatment for them is worth thinking about.”

The study will be published in the American Journal of Respiratory and Critical Care Medicine. A copy of the CAT questionnaire is available for free download.

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Readers' comments (1)

  • As a Paramedic in the Ambulance Service we see a large number of COPD patients, the CAT score would help Paramedics when assessing patients and considering refering to either GP, COPD Nurse or ECP as opposed the norm which is transporatation to the ED. It would be great if for once we could all speak the same language and work to the same standards. A useful tool to have.

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