High COPD Assessment Score May Predict Anxiety Levels in Patients

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A high assessment test score for chronic obstructive pulmonary disease (COPD) may predict anxiety in patients, a recent study reported.

A high assessment test score for chronic obstructive pulmonary disease (COPD) may predict anxiety in patients, a recent study reported.

The researchers wrote that the results indicate that anxiety must be investigated in patients with COPD, especially when their COPD assessment test (CAT) score is 20 or higher. Additional analysis with a larger sample size should further evaluate the value of CAT score correlation with anxiety in patients with COPD. A higher CAT score is associated with increased COPD symptoms.

Anxiety is prevalent in 55% of patients with COPD and is associated with worse disease control. To better understand anxiety in COPD, the CAT score was correlated with the Hospital Anxiety and Depression Scale (HADS) to determine the level at which CAT may predict anxiety.

The study took place in Australia, where data were collected from 100 patients with confirmed COPD. Seventy-eight patients completed spirometry.


COPD severity was graded according to criteria set by Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, and the CAT and HADS scores were collected on 2 consecutive visits separated by 6 months, with a 100% completion rate.

A total of 45 patients had clinically significant anxiety on the first visit and 38 patients on the second visit.

The severity of the cohort was classified as GOLD 1 (n = 2 patients), GOLD 2 (n = 29), GOLD 3 (n = 39), and GOLD 4 (n = 8).

In the first visit, the prevalence of anxiety in GOLD 1 was 0%, in GOLD 2 was 45% (n = 13 patients), in GOLD 3 was 56% (n = 22), and in GOLD 4 was 38% (n = 3).

Data from the second visit were similar, apart from a decreased prevalence in GOLD 3 (43%) and an increased prevalence in GOLD 4 (67%).

A CAT score was found to have significant correlation with anxiety with an odds ratio of 1.25 (95% CI, 1.13-1.4). At each visit, the CAT score could discriminate between those with anxiety and those without.

In visit 1, area under receiver operating characteristic curve was 0.74 (95% CI, 0.64-0.84), and in visit 2, area under the receiver operating characteristic curve was 0.76 (95% CI, 0.66-0.85). A CAT cutoff score of 20 or higher gives a sensitivity of 80% and 84% and an acceptable specificity of 52% and 47% in visit 1 and visit 2, respectively.

The change in mean forced expiratory volume in 1 second from the first visit to the second did not correlate with the change in CAT (R2 = 0.03), which requires further study.

These pilot data suggest that CAT scores may identify patients with anxiety and form the basis for future studies with a larger sample size.


Harryanto H, Burrows S, Moodley Y. A high COPD assessment test score may predict anxiety in COPD. Int J Chron Obstruct Pulmon Dis. 2018;13:955-957. doi: 10.2147/COPD.S152950.