To achieve these goals, COPD assessment must consider the following aspects of the disease

separately:

Current level of patients symptoms

Severity of the spirometric abnormality

Exacerbation risk

Presence of comorbidities

Assessment of Symptoms

In the past, COPD was viewed as a disease largely characterized by breathlessness. A simple measure
of breathlessness such as the Modified British Medical Research Council (mMRC) Questionnaire was
considered adequate for assessment of symptoms, as the mMRC relates well to other measures of
health status and predicts future mortality risk. However, it is now recognized that COPD has multiple
symptomatic effects. For this reason, a comprehensive symptom assessment is recommended rather
than just a measure of breathlessness. The most comprehensive disease-specific health-related
quality of life or health status questionnaires such as the CRQ236 and SGRQ347 are too complex to
use in routine practice, but two shorter comprehensive measures (COPD Assessment Test, CAT and
COPD Control Questionnaire, CCQ) have been developed and are suitable.

COPD Assessment Test (CAT). The COPD Assessment Test is an 8-item unidimensional measure of
health status impairment in COPD124. It was developed to be applicable worldwide and validated
translations are available in a wide range of languages. The score ranges from 0-40, correlates very
closely with the SGRQ, and has been extensively documented in numerous publications548
(http://www.catestonline.org).

The CAT and CCQ provide a measure of the symptomatic impact of COPD but do not categorize patients into
lower and higher symptoms for the purpose of treatment. The SGRQ is the most widely documented
comprehensive measure; scores less than 25 are uncommon in diagnosed COPD patients 131,549 and scores 25
are very uncommon

may be adequate for breathlessness assessment, it will also categorize a number of patients with
symptoms other than breathlessness as having few symptoms. For this reason, the use of a
comprehensive symptom assessment is recommended. However, because use of the mMRC is still
widespread, an mMRC of 2 is still included as a cut-point for separating less breathlessness from
more breathlessness. However, users are cautioned that assessment of other symptoms is
required554,555.
Spirometric Assessment
Table 2.5 shows the classification of airflow limitation severity in COPD. Specific spirometric cut-
points are used for purposes of simplicity. Spirometry should be performed after the administration of
an adequate dose of a short-acting inhaled bronchodilator in order to minimize variability.
However, there is only a weak correlation between FEV 1, symptoms and impairment of a patients health-
related quality of life. This is illustrated in Figure 2.2 in which health-related quality of life is plotted against
post-bronchodilator FEV1126,127 with the GOLD spirometric classification superimposed. The figure illustrates that,
within any given category, patients may have anything between relatively well preserved to very poor health
status. For this reason, formal symptomatic assessment is also required.