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A multicenter family practitioners’ research on Chronic Obstructive Pulmonary Disease screening using the COPD Assessment Test

  • Hakan Demirci (a1), Koncuy Eniste (a2), Ebru Onuker Basaran (a3), Gokhan Ocakoglu (a4), Zeynep Yilmaz (a1) and Sumeyye Tuna (a1)...

Spirometry is known to be a gold standard for the diagnosis of chronic obstructive pulmonary disease (COPD). COPD Assessment Test (CAT) is an eight-item questionnaire currently in use to evaluate patients with COPD. In the present study, we aimed to evaluate if CAT is an adequate tool for screening COPD.


In total, 600 persons aging ⩾40 years old were randomly selected from three different family practice units located in the city center. CAT was asked to the participants and a spirometry was used to assess pulmonary obstruction. Pulmonary obstruction was defined as forced expiratory volume in first second/forced vital capacity (FEV1/FVC)<70% and then COPD diagnosis was confirmed with the reversibility test. The relationship between CAT results and pulmonary function test values was evaluated.


In this sampling, the prevalence of COPD was 4.2%. Reliability of the CAT in the study group was acceptable (Cronbach’s α: 0.84). The CAT scores was significantly higher in patients with COPD (P<0.001). There was a significant negative correlation between CAT score and FEV1, FVC and FEV1/FVC ratio (r=−0.31, P<0.001; r=−0.26, P<0.001; r=0.18, P=0.001). Among smokers, phlegm was the predominating symptom (P=0.01). Sensitivity of CAT was 66.67% and its specificity was 75.15% to determine COPD.


CAT is a reliable questionnaire and there is an apparent relationship between the total CAT scores and COPD. However, CAT’s ability to screen COPD is limited since it may miss the symptom-free cases.

Corresponding author
Correspondence to: Associate Professor Hakan Demirci, Family Medicine, University of Health Sciences Bursa Yuksek Ihtisas Egitim ve Arastırma Hastanesi, Yildirim, Bursa 16310, Turkey. Email:
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Arslan Z., Ilgazlı A., Etiler N. and Hamzaoğlu O. 2013: Prevalence of chronic obstructive pulmonary disease in Kocaeli: an industrialised city in Turkey. Balkan Medical Journal 30, 387393.
Battaglia S., Basile M., Scichilone N. and Bellia V. 2015: Prevalence of co-morbidities and severity of COPD. COPD 12, 390394.
Centers for Disease Control and Prevention. 2012: Chronic obstructive pulmonary disease among adults – United States, 2011. Morbidity and Mortality Weekly Report 61, 938943.
Dales R.E., Vandemheen K.L., Clinch J. and Aaron S.D. 2005: Spirometry in the primary care setting. Influence on clinical diagnosis and management of airflow obstruction. Chest 128, 24432447.
Deveci F., Deveci S.E., Turkoglu S., Turgut T., Kirkil G., Rahman S., Açik Y. and Muz M.H. 2011: The prevalence of chronic obstructive pulmonary disease in Elazig, Eastern Turkey. European Journal of Internal Medicine 22, 172176.
Dikis O.S., Dulger S.U., Karadag M. and Demirci H. 2015: COPD cases detected by Spirometry on world COPD day event in Bursa. European Respiratory Journal 1, 6165.
Dinc M., Maden E. and Uzun K. 2014: The availability of COPD Assessment Test (CAT) in determination of risk of early hospitalization in chronic obstructive pulmonary disease patients and its correlation with pulmonary function tests, dyspnea measurement scales and St George respiratory questionnaire. European Respiratory Journal 44, 4726.
Domingo-Salvany A., Lamarca R., Ferrer M., Khalaf A., Marrades R.M., Monsó E., Serra-Batlles J. and Antó J.M. 2002: Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 166, 680685.
Enright P. 2006: Does screening for COPD by primary care physicians have the potential to cause more harm than good? Chest 129, 833834.
Ferrer M., Alonso J., Morera J., Marrades R.M., Khalaf A., Aguar C., Plaza V., Prieto L. and Anto J.M. 1997: Chronic obstructive pulmonary disease stage and health-related quality of life. Annals of Internal Medicine 127, 10721079.
Ford E.S., Croft J.B., Mannino D.M., Wheaton A.G., Zhang X. and Giles W.H. 2013: COPD surveillance – United States, 1999-2011. Chest 144, 284305.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). 2016: Global strategy for the diagnosis, management and prevention of COPD. Retrieved 25 February 2017 from
Gunen H., Hacievliyagil S.S., Yetkin O., Gulbas G., Mutlu L.C. and Pehlivan E. 2008: Prevalence of COPD: first epidemiological study of a large region in Turkey. European Journal of Internal Medicine 19, 499504.
IBM Corporation. 2012. IBM SPSS statistics for Windows, version 21.0. Armonk, NY: IBM Corporation.
Joo M.J., Sharp L.K., Au D.H., Lee T.A. and Fitzgibbon M.L. 2013: Use of spirometry in the diagnosis of COPD: a qualitative study in primary care. COPD 10, 444449.
Lin K., Watkins B., Johnson T., Rodriguez J.A. and Barton M.B. 2008: Screening for chronic obstructive pulmonary disease using spirometry: summary of the evidence for the US Preventive Services Task Force. Annals of Internal Medicine 148, 535543.
Omachi T.A., Katz P.P., Yelin E.H., Gregorich S.E., Iribarren C., Blanc P.D. and Eisner M.D. 2009: Depression and health-related quality of life in chronic obstructive pulmonary disease. The American Journal of Medicine 122, 778779.
Raghavan N., Lam Y.M., Webb K.A., Guenette J.A., Amornputtisathaporn N., Raghavan R., Tan W.C., Bourbeau J. and O’Donnell D.E. 2012: Components of the COPD Assessment Test (CAT) associated with a diagnosis of COPD in a random population sample. COPD 9, 175183.
Sánchez-Nieto J.M., Andújar-Espinosa R., Bernabeu-Mora R., Hu C., Gálvez-Martínez B., Carrillo-Alcaraz A., Álvarez-Miranda C.F., Meca-Birlanga O. and Abad-Corpa E. 2016: Efficacy of a self-management plan in exacerbations for patients with advanced COPD. International Journal of Chronic Obstructive Pulmonary Disease 11, 19391947.
Seemungal T.A., Donaldson G.C., Paul E.A., Bestall J.C., Jeffries D.J. and Wedzicha J.A. 1998: Effects of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine 157, 14181422.
Silva Júnior J.L., Conde M.B., de Sousa Corrêa K., da Silva C., da Silva Prestes L. and Rabahi M.F. 2014: COPD Assessment Test (CAT) score as a predictor of major depression among subjects with chronic obstructive pulmonary disease and mild hypoxemia: a case-control study. BMC Pulmonary Medicine 14, 186.
Van Schayck C., Loozen J.M.C., Wagena E., Akkermans R.P. and Wesseling G.J. 2002: Detecting patients at a high risk of developing chronic obstructive pulmonary disease in general practice: cross-sectional case finding study. BMJ 324, 1370.
Yorgancıoğlu A., Polatlı M., Aydemir Ö., Yılmaz D.N., Kırkıl G., Naycı A.S., Köktürk N., Uysal A., Akdemir S.E., Ozgur E.S. and Günakan G. 2011: Reliability and validity of Turkish version of COPD assessment test. Tuberkuloz ve toraks 60, 314320.
Yoshimoto D., Nakano Y., Onishi K., Hagan G. and Jones P. 2014: The relationship between the COPD Assessment Test score and airflow limitation in Japan in patients aged over 40 years with a smoking history. International Journal of Chronic Obstructive Pulmonary Disease 9, 13571363.
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
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