How to determine an impaired health status in COPD: Results from a population-based study

D E Smid, M A Spruit, D J H Deeg, M Huisman, J Poppelaars, E F M Wouters, F M E Franssen

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BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with a significantly impaired health status and lost work productivity across all degrees of airflow limitation. The current study investigated whether an impaired health status is better represented by the recommended COPD Assessment Test (CAT) cut-point of 10 points, or the 95th percentile of the CAT score in a non-COPD population. Additionally, the impact of COPD on health status in a Dutch population, after stratification for work status, was measured.

METHODS: Demographics, clinical characteristics, post-bronchodilator spirometry, and CAT were assessed in subjects from the Longitudinal Aging Study Amsterdam (LASA), a large Dutch population-based study. Normative values for the CAT score were described by percentiles using the mean, standard deviation, median and range.

RESULTS: In total, 810 COPD and non-COPD subjects (50.4% male, mean age 60.5 ±; 2.9 years) were analysed. Significant differences were observed in CAT scores between non-COPD and COPD subjects (6.7 ±; 5.2 vs. 9.5 ±; 5.9, p < 0.001 respectively). The proportion of COPD subjects with an impaired health status differed between applying the CAT ≥ 10 cut-point (50.0%) and applying the 95th percentile of CAT in non-COPD subjects (> 18 cut-point; 7.6%). Higher CAT scores were seen in working COPD patients compared with working non-COPD subjects (9.3 ±; 5.2 vs. 6.0 ±; 4.6, p < 0.001).

CONCLUSION: We suggest a CAT cut-point of > 18 points to indicate an impaired health status in COPD. This would imply an adaptation of the current GOLD classification of the disease.

Original languageEnglish
Pages (from-to)151-157
Number of pages7
JournalNetherlands Journal of Medicine
Issue number4
Publication statusPublished - May 2017


We are grateful to all the respondents who were willing to participate in the current study. Subsequently, the authors would like to thank M. Akkermans and J. Oosterbaan for helping with collecting and converting the spirometry data. The Longitudinal Aging Study Amsterdam was financially supported by the Ministry of Health, Welfare and Sports (to the VU University for the The Longitudinal Aging Study Amsterdam). DES was financially supported by GlaxoSmithKline (SCO115406). The funding sources had no involvement in the study design, data collection, analysis and interpretation of data, writing of the report, and/or decision to submit the article for publication.

FundersFunder number
Vrije Universiteit Amsterdam
Ministerie van Volksgezondheid, Welzijn en Sport


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