COPD Assessment Test (CAT)

CAT Calculator

Cough

Phlegm

Chest Tightness

Breathlessness Going Up Hills/Stairs

Activity Limitation at Home

Confidence Leaving Home

Sleep Quality

Energy

Total CAT Score: –

Score: 0

Default scoring assumes 0 for un-set fields.

Quantifies impact o f COPD symptoms on patients' overall health.

Why Use

Provides a validated and universally agreed-upon framework for quantifying symptom burden and risk for exacerbation (along with spirometry), which can be used to guide therapy. Recommended by GOLD Guidelines (along with the mMRC Dyspnea Scale ) for evaluation of all patients with COPD. Quicker and more practical to complete than other questionnaire-based assessments such as St. George’s Respiratory Questionnaire or Chronic Respiratory Questionnaire.

When to Use

Use in patients with diagnosed COPD when assessing progression of lung disease and decline in functional status.

Formula

Addition of the selected points (rate each symptom on a scale of 0-5, 0 being no symptoms at all and 5 being the most severe): Symptom Points Cough 0 (“I never cough”) 1 2 3 4 5 (“I cough all the time”) Phlegm 0 (“I have no phlegm in my chest at all”) 1 2 3 4 5 (“My chest is completely full of phlegm”) Chest tightness 0 (“My chest does not feel tight at all”) 1 2 3 4 5 (“My chest feels very tight”) Breathlessness 0 (“When I walk up a hill or one flight of stairs I am not breathless”) 1 2 3 4 5 (“When I walk up a hill or one flight of stairs I am very breathless”) Activities 0 (“I am not limited doing any activities at home”) 1 2 3 4 5 (“I am very limited doing any activities at home”) Confidence 0 (“I am confident leaving my home despite my lung condition”) 1 2 3 4 5 (“I am not at all confident leaving my home because of my lung condition”) Sleep 0 (“I sleep soundly”) 1 2 3 4 5 (“I don’t sleep soundly because of my lung condition”) Energy 0 (“I have lots of energy”) 1 2 3 4 5 (“I have no energy at all”)

Pearls / Pitfalls

Developed to address COPD burden in daily life, not to diagnose COPD. CAT scores have been shown to correlate with mortality ( Husebø 2016 ) as well as patient-reported symptom improvement ( Dodd 2011 ).

Advice

Note that the CAT is one component in clinical decision-making, along with other considerations such as history of previous exacerbations and airflow limitation ( FEV1 ). For all COPD patients, smoking cessation, preventive care (e.g. annual flu/pneumococcal vaccinations), and reduced exposure to exacerbation risk factors are mainstays of management ( GOLD Guidelines ). GOLD Guidelines recommend CAT as one component in grading symptom burden and to categorize patients into one of three groups: A, B, or E. CAT ≥10 corresponds to either GOLD Group B or E. Group B patients should be started on LABA and LAMA, although single inhaler therapy may be considered to improve adherence. Group E patients should also be started on LABA and LAMA. ICS should be considered in this group if their blood eosinophils are ≥ 300. CAT <10 corresponds to GOLD Group A or E. Group A patients should be started on a bronchodilator. Group E patients should also be started on LABA and LAMA. ICS should be considered in this group if their blood eosinophils are ≥300.

More Information

Interpretation: CAT Score Health impact Recommendation 0-10 Low Smoking cessation, preventive care, reduced exposure to exacerbation risk factors, LAMA, LABA, and rescue inhalers. ICS can be considered in Group E patients with elevated blood eosinophils. 11-20 Medium Smoking cessation, preventive care, reduced exposure to exacerbation risk factors, LAMA, LABA, and rescue inhalers. ICS can be considered in Group E patients with elevated blood eosinophils. Consider referrals for pulmonary rehab and possible lung transplant evaluation. 21-30 High Smoking cessation, preventive care, reduced exposure to exacerbation risk factors, LABA, LAMA, and rescue inhalers. ICS can be considered in Group E patients with elevated blood eosinophils. O2 supplementation if appropriate. Consider referrals for pulmonary rehab and possible lung transplant evaluation. 31-40 Very high From GOLD Guidelines 2023 .