How to Take a COPD Assessment Test (CAT)

Simple, Self-Evaluation Can Tell You a Lot About Your Condition

Senior woman at doctor's office.
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There are a number of questionnaires that doctors use to assess the severity and impact of chronic obstructive pulmonary disease (COPD). One of them is called the COPD assessment test, also known as the CAT. It is comprised of eight questions in which patients rate both their symptoms and the relative level of impairment.

Why the CAT is Important

The year 2011 was characterized by a seachange in how COPD was approached. It was then that the scientific committee of the Global Initiative for Obstructive Lung Disease (GOLD) issued recommendations stating that COPD should no longer be treated based solely on diagnostic tests like spirometry. The GOLD committee recognized that these tests, while valuable, had shortcomings in their ability to assess what a person was experiencing.

In some cases, for example, a person with COPD may be diagnosed with minor impairment but be unable to walk up a flight of stairs. By contrast, a person with moderate impairment may function more normally than the diagnostic tests were able to suggest.

The updated guidelines acknowledged that the expression of COPD is based on many intersecting factors, including the restriction of respiratory function, the frequency of exacerbations, and the person's own perception of their illness. The CAT helps to quantify these factors based on the patient's experience.

Where to Take the Test

You can take the CAT at home by printing it out from the official CAT website, where it is available for free download in 57 different languages. After you complete the test at home, bring the completed test into your doctor to read the results. You may also request to take the test in its entirety at your doctor's office and discuss the results right there and then.

How the CAT Works

The CAT is both simple and highly descriptive. The eight questions are each rated on a scale of 0 to 5. The numbers are then tallied for a score of 0 to 40. The higher the number, the more serious the impairment. The range of questions is related to different aspects of the disease, as follows:

  1. Cough - rated from 0 for "I never cough" to 5 for "I cough all the time"
  2. Mucus - rated from 0 for "I have no mucus at all" to 5 for "My chest is completely full of mucus"
  3. Chest tightness - rated from 0 for "My chest does not feel tight at all" to 5 for "My chest feels very tight"
  4. Shortness of breath - rated from 0 for "When I walk up one flight of stairs, I am not breathless" to 5 for "When I walk up one flight of stairs I am very breathless"
  5. Activity restriction at home - rated from 0 for "I am not limited doing any activities at home" to 5 for "I am very limited doing activities at home"
  6. Activity restriction outside of the home - rated from 0 for "I am confident leaving my home despite my lung condition" to 5 for "I am not at all confident leaving my home because of my lung condition"
  7. Impact on sleep - rated from 0 for "I sleep soundly" to 5 for "I don’t sleep soundly because of my lung condition"
  8. Impact on energy - rated from 0 for "I have lots of energy" to 5 for "I have no energy at all"

    What the Results Tell Us

    While the CAT is not used to diagnose COPD and cannot replace COPD treatments, it is valuable in the following areas:

    • To determine when treatment should be started
    • To determine how many treatments should be prescribed
    • To understand how well or poorly a person is responding to treatment

    Based on the GOLD guidelines, persons with scores higher than 10 should receive daily therapy as soon as possible. Moreover, any increase of more than two—either up or down—is considered a significant change in symptom control. Any upward trend is considered a deterioration while a downward trend is considered an improvement.or

    It may be helpful to take the CAT every few months, to get an idea of how your condition changes over time and with different treatment options.

    Benefits and Downsides of Using CAT

    The CAT is heralded as a quick, easy, and painless way to get an objective look at how COPD impacts your life. Ultimately, it can help improve your patient-doctor communication about the disease.

    While not all clinicians have adopted the CAT in their daily practice, some studies suggest that it may be useful in predicting the risk of exacerbations, the development of depression, and the progression of symptomatic disease.

    In contrast, other studies have shown that using CAT is not an effective way to evaluate the measure of lung function—that it only provides a look at the disease's impact on a person's health status.

    A Word From Verywell

    The CAT is a simple, noninvasive test that can give both you and your doctor quantitative insight into your COPD condition and see how well you're responding to care. While taking this test can't help you diagnose the disease, it's a great, free tool to use if you've been battling the condition that can help you monitor your therapy.

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