Chronic Airways Assessment Test: psychometric properties in patients with asthma and/or COPD
Authors: Tomaszewski Erin L. , Atkinson Mark J. , Janson Christer , Karlsson Niklas , Make Barry , Price David , Reddel Helen K. , Vogelmeier Claus F. , Müllerová Hana , Jones Paul W. ,   NOVELTY Scientific Community;, del Olmo Ricardo , Anderson Gary , Reddel Helen , Rabahi Marcelo , McIvor Andrew , Sadatsafavi Mohsen , Weinreich Ulla , Burgel Pierre-Régis , Devouassoux Gilles , Papi Alberto , Inoue Hiromasa , Rendon Adrian , van den Berge Maarten , Beasley Richard , García-Navarro Alvar Agustí , Faner Rosa , Rivera José Olaguibel , Janson Christer , Bilińska-Izydorczyk Magdalena , Fagerås Malin , Fihn-Wikander Titti , Franzén Stefan , Keen Christina , Ostridge Kristoffer , Chalmers James , Harrison Timothy , Pavord Ian , Price David , Azim Adnan , Belton Laura , Blé Francois-Xavier , Erhard Clement , Gairy Kerry , Hughes Rod , Lassi Glenda , Müllerová Hana , Rapsomaniki Eleni , Scott Ian Christopher , Chipps Bradley , Make Barry , Christenson Stephanie , Tomaszewski Erin ,   NOVELTY study investigators, del Olmo Ricardo , Benhabib Gabriel , Ruiz Xavier Bocca , Lisanti Raul Eduardo , Marino Gustavo , Mattarucco Walter , Nogueira Juan , Parody Maria , Pascale Pablo , Rodriguez Pablo , Silva Damian , Svetliza Graciela , Victorio Carlos F. , Rolon Roxana Willigs , Yañez Anahi , Reddel Helen , Baines Stuart , Bowler Simon , Bremner Peter , Bull Sheetal , Carroll Patrick , Chaalan Mariam , Farah Claude , Hammerschlag Gary , Hancock Kerry , Harrington Zinta , Katsoulotos Gregory , Kim Joshua , Langton David , Lee Donald , Peters Matthew , Prassad Lakshman , Sajkov Dimitar , Santiago Francis , Simpson Frederick Graham , Tai Sze , Thomas Paul , Wark Peter , Rabahi Marcelo , Cançado José Eduardo Delfini , Cunha Thúlio , Lima Marina , Cardoso Alexandre Pinto , FitzGerald J. Mark , McIvor Andrew , Anees Syed , Bertley John , Bell Alan , Cheema Amarjit , Chouinard Guy , Csanadi Michael , Dhar Anil , Dhillon Ripple , Kanawaty David , Kelly Allan , Killorn William , Landry Daniel , Luton Robert , Mandhane Piushkumar , Pek Bonavuth , Petrella Robert , Stollery Daniel , Wang Chen , Chen Meihua , Chen Yan , Gu Wei , Hui Kim Ming Christopher , Li Manxiang , Li Shiyue , Lijun Ma , Qin Guangyue , Song Weidong , Tan Wei , Tang Yijun , Wang Tan , Wen Fuqiang , Wu Feng , Xiang PingChao , Xiao Zuke , Xiong Shengdao , Yang Jinghua , Yang Jingping , Zhang Caiqing , Zhang Min , Zhang Ping , Zhang Wei , Zheng Xiaohe , Zhu Dan , Bueno Carlos Matiz , Grimaldos Fabio Bolivar , Arboleda Alejandra Cañas , de Salazar Dora Molina , Weinreich Ulla , Bendstrup Elisabeth , Hilberg Ole , Kjellerup Carsten , Burgel Pierre-Régis , Devouassoux Gilles , Raherison Chantal , Bonniaud Philippe , Brun Olivier , Chouaid Christos , Couturaud Francis , de Blic Jacques , Debieuvre Didier , Delsart Dominique , Demaegdt Axelle , Demoly Pascal , Deschildre Antoine , Egron Carole , Falchero Lionel , Goupil François , Kessler Romain , Le Roux Pascal , Mabire Pascal , Mahay Guillaume , Martinez Stéphanie , Melloni Boris , Moreau Laurent , Riviere Emilie , Roux-Claudé Pauline , Soulier Michel , Vignal Guillaume , Yaici Azzedine , Bals Robert , Aries Sven Philip , Beck Ekkehard , Deimling Andreas , Feimer Jan , Grimm-Sachs Vera , Growth Gesine , Herth Felix , Hoheisel Gerhard , Kanniess Frank , Lienert Thomas , Mronga Silke , Reinhardt Jörg , Schlenska Christian , Stolpe Christoph , Teber Ishak , Timmermann Hartmut , Ulrich Thomas , Velling Peter , Wehgartner-Winkler Sabina , Welling Juergen , Winkelmann Ernst-Joachim , Papi Alberto , Barbetta Carlo , Braido Fulvio , Cardaci Vittorio , Clini Enrico Maria , Costantino Maria Teresa , Cuttitta Giuseppina , di Gioacchino Mario , Fois Alessandro , Foschino-Barbaro Maria Pia , Gammeri Enrico , Inchingolo Riccardo , Lavorini Federico , Molino Antonio , Nucera Eleonora , Patella Vincenzo , Pesci Alberto , Ricciardolo Fabio , Rogliani Paola , Sarzani Riccardo , Vancheri Carlo , Vincenti Rigoletta , Inoue Hiromasa , Endo Takeo , Fujita Masaki , Hara Yu , Horiguchi Takahiko , Hosoi Keita , Ide Yumiko , Inomata Minehiko , Inoue Koji , Inoue Sumito , Kato Motokazu , Kawasaki Masayuki , Kawayama Tomotaka , Kita Toshiyuki , Kobayashi Kanako , Koto Hiroshi , Nishi Koichi , Saito Junpei , Shimizu Yasuo , Shirai Toshihiro , Sugihara Naruhiko , Takahashi Ken-ichi , Tashimo Hiroyuki , Tomii Keisuke , Yamada Takashi , Yanai Masaru , Rendon Adrian , Javier Ruth Cerino , Peregrina Alfredo Domínguez , Corzo Marco Fernández , Gonzalez Efraín Montano , Ramírez-Venegas Alejandra , van den Berge Maarten , Boersma Willem , Djamin R. S. , Eijsvogel Michiel , Franssen Frits , Goosens Martijn , Graat-Verboom Lidwien , in’t Veen Johannes , Janssen Rob , Kuppens Kim , van de Ven Mario , Bakke Per , Brunstad Ole Petter , Einvik Gunnar , Høines Kristian Jong , Khusrawi Alamdar , Oien Torbjorn , Yoon Ho Joo , Chang Yoon-Seok , Cho Young Joo , Hwang Yong Il , Kim Woo Jin , Koh Young-Il , Lee Byung-Jae , Lee Kwan-Ho , Lee Sang-Pyo , Lee Yong Chul , Lim Seong Yong , Min Kyung Hun , Oh Yeon-Mok , Park Choon-Sik , Park Hae-Sim , Park Heung-Woo , Rhee Chin Kook , Yoon Hyoung-Kyu , García-Navarro Alvar Agustí , Rivera José Olaguibel , Andújar Rubén , Anoro Laura , García María Buendía , Mozo Paloma Campo , Campos Sergio , Maldonado Francisco Casas , Martínez Manuel Castilla , Serrano Carolina Cisneros , Casanova Lorena Comeche , Corbacho Dolores , Del Campo Matías Felix , Echave-Sustaeta Jose , Corral Gloria Francisco , Setién Pedro Gamboa , Clemente Marta García , Núñez Ignacio García , Robaina Jose García , Salmones Mercedes García , Trigo Jose Maria Marín , Fernandez Marta Nuñez , Palomo Sara Nuñez , de Llano Luis Pérez , Bastida Ana Pueyo , Rañó Ana , González-Moro José Rodríguez , Reig Albert Roger , Garrido José Velasco , Janson Christer , Curiac Dan , Lif-Tiberg Cornelia , Luts Anders , Råhlen Lennart , Rustscheff Stefan , Harrison Timothy , Adams Frances , Bradman Drew , Broughton Emma , Cosgrove John , Flood-Page Patrick , Fuller Elizabeth , Hartley David , Hattotuwa Keith , Jones Gareth , Lewis Keir , McGarvey Lorcan , Morice Alyn , Pandya Preeti , Patel Manish , Roy Kay , Sathyamurthy Ramamurthy , Thiagarajan Swaminathan , Turner Alice , Vestbo Jorgen , Wedzicha Wisia , Wilkinson Tom , Wilson Pete , Chipps Bradley , Al-Asadi Lo’Ay , Anholm James , Averill Francis , Bansal Sandeep , Baptist Alan , Campbell Colin , Campos Michael A. , Crook Gretchen , DeLeon Samuel , Eid Alain , Epstein Ellen , Fritz Stephen , Harris Hoadley , Hewitt Mitzie , Holguin Fernando , Hudes Golda , Jackson Richard , Kaufman Alan , Kaufman David , Klapholz Ari , Krishna Harshavardhan , Lee Daria , Lin Robert , Maselli-Caceres Diego , Mehta Vinay , Moy James N. , Nwokoro Ugo , Parikh Purvi , Parikh Sudhir , Perrino Frank , Ruhlmann James , Sassoon Catherine , Settipane Russell A. , Sousa Daniel , Sriram Peruvemba , Wachs Richard 
Published: April 2023

Abstract
Background
No short patient-reported outcome (PRO) instruments assess overall health status across different obstructive lung diseases. Thus, the wording of the introduction to the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was modified to permit use in asthma and/or COPD. This tool is called the Chronic Airways Assessment Test (CAAT).

Methods
The psychometric properties of the CAAT were evaluated using baseline data from the NOVELTY study (NCT02760329) in patients with physician-assigned asthma, asthma + COPD or COPD. Analyses included exploratory/confirmatory factor analyses, differential item functioning and analysis of construct validity. Responses to the CAAT and CAT were compared in patients with asthma + COPD and those with COPD.

Results
CAAT items were internally consistent (Cronbach’s alpha: > 0.7) within each diagnostic group (n = 510). Models for structural and measurement invariance were strong. Tests of differential item functioning showed small differences between asthma and COPD in individual items, but these were not consistent in direction and had minimal overall impact on the total score. The CAAT and CAT were highly consistent when assessed in all NOVELTY patients who completed both (N = 277, Pearson’s correlation coefficient: 0.90). Like the CAT itself, CAAT scores correlated moderately (0.4–0.7) to strongly (> 0.7) with other PRO measures and weakly (< 0.4) with spirometry measures.

Conclusions
CAAT scores appear to reflect the same health impairment across asthma and COPD, making the CAAT an appropriate PRO instrument for patients with asthma and/or COPD. Its brevity makes it suitable for use in clinical studies and routine clinical practice.
Trial registration: NCT02760329.