Questionnaire helps gauge how serious one’s condition is

A NEW, self-administered questionnaire which measures the impact of a group of lung diseases on a patient is available in Singapore, and some doctors are planning to use it with their patients.

The eight items in the test will give a framework for discussions between doctors and their patients who have chronic obstructive pulmonary disease (COPD), a spectrum of lung ailments causing breathing difficulties and at the root of about 5,000 hospital cases a year.

The COPD Assessment Test, or CAT for short, can also be used to track the progress of the illness in a patient if test scores are compared over time.

Patients taking the test must respond to eight pairs of statements, which include: I am confident leaving my home despite my lung condition/I am not at all confident leaving my home because of my lung condition, and I never cough/I cough all the time.

They rate each pair of statements on a five-point scale; the higher a patient’s total score, the more serious his condition, and the more he needs specialist care.

A patient who scores a high 35 out of a possible 40 is probably someone whose condition stops him from doing simple activities. Even walking would cause breathlessness.

The CAT was launched last Saturday before an audience of 120 respiratory specialists, general practitioners and nurses.

Professor Paul Jones, who heads the division of clinical science at St George’s University of London which developed the test, explained that CAT is not a diagnostic tool, but a way of forming an overall picture of the impact of COPD on the patient.

No other test practical enough for daily use does this now.

A number of other lung-function tests – including those not comprehensive enough to use on their own and some too complicated to administer – are still required to confirm a diagnosis of COPD, he added.

But he pointed out CAT would come in handy, given that COPD is under-managed worldwide, partly because of difficulties in describing and assessing its full impact.

Patients get used to their symptoms over time and so understate the severity of their disease when asked, he added.

A test like spirometry, which measures how fast and how much air one can blow out of one’s lungs, looks only at specific aspects of the disease, such as breathlessness.

Another test, the St George’s Respiratory Questionnaire, has 50 questions, making it too complex to be used in daily practice. There is no cure for COPD, which came in at No. 8 on the list of leading causes of death in Singapore in 2008.

A Health Ministry spokesman said it does not regulate the use of tests such as CAT and advised doctors who wish to use such instruments to understand how it was developed.

The heads of departments for respiratory medicine in the public hospitals here say they are open to using CAT in their patient assessments, though they will not make it compulsory in their clinics
now.

Dr Augustine Tee, a consultant in respiratory medicine in Changi General Hospital, did a pilot test with CAT on 50 patients this year.

Patients told him they found the questions comprehensive, although some needed help in completing the test because of language and cultural differences.

The test, available only in English and Chinese now, is being translated into other languages.

Prof Jones explained that the CAT could, however, turn out less than useful in those patients who have other conditions like heart failure.

It is also not totally comprehensive as patients’ lives can be affected in more ways than those listed on the test.