Determinants of high chronic obstructive pulmonary disease assessment test scores according to airflow limitation severity: a three-year prospective study.

BACKGROUND: The determinants of chronic obstructive pulmonary disease (COPD) assessment test (CAT) scores according to airflow limitation severity are not fully understood. METHODS: We aimed to elucidate this by analyzing data from 378 patients with COPD, categorized into two groups based on airflow limitation severity (FEV1 > 50% [GOLD-mild] and ≤ 50% [GOLD-severe]). Within each severity group, patients were further sub-stratified by CAT score (≥ 10 vs. <10). RESULTS: Patients with CAT scores ≥ 10 in the GOLD-mild group were older, with more severe airflow limitation and higher prevalence of gastroesophageal reflux disease (GERD), anxiety, depression, and diabetes, whereas those in the GOLD-severe group showed higher GERD and asthma prevalences. GERD and asthma contributed predominantly to respiratory-specific items. Airflow limitation and GERD were strong determinants in both severity groups. Key determinants were anxiety and depression in the GOLD-mild group and asthma in the GOLD-severe group. These associations remained consistent over 3 years. CONCLUSIONS: These findings offer valuable insights for managing patients with pronounced subjective symptoms in COPD.