Kronik obstrüktif akciğer hastalarında KOAH değerlendirme testi (CAT)'nin solunumsal fonksiyon testleri, dispne ölçüm skalaları, ST . georges solunumsal anketi ile korelasyonu ve erken dönem hastaneye yatış riskini belirlemede kullanılabilirliği
The availibilty of copd assessment test (cat)in determination of risk of early hospitalization in chronic obstructive pulmonary disease patients and its corelation with pulmonary function tests, dyspnea measurement scales and ST george  S respiratory quastionnare
Yazar: MUSTAFA DİNÇ
Danışman: DOÇ. DR. EMİN MADEN
Necmettin Erbakan Üniversitesi / Meram Tıp Fakültesi / Göğüs Hastalıkları ve Tüberküloz Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2013
Konu: Göğüs Hastalıkları = Chest Diseases
Dizin: Akciğer hastalıkları = Lung diseases ; Akciğer hastalıkları-obstrüktif = Lung diseases-obstructive ; Dispnea = Dyspnea ; Solunum fonksiyon testleri = Respiratory function tests ; Solunum fonksiyon testleri = Respiratory function tests ; Ölçekler = Scales

Özet:
Bulgular: Çalışmaya 48 erkek (%92,3) ve 4 kadın (%7,7) olmak üzere 52 hasta alındı.
Ortalama yaş 64 ± 9 (40-80) idi. Ortalama hastalık süresi 10,7 ± 7 (1-30) yıl iken ortalama sigara
(46 hasta) paket/yıl 51,8 ±25 (15-150) idi. Hastaların 19‟u (%36,5) poliklinik hastasıyken 33‟ü
(%63,5) serviste takip edilen hastalardan oluşmaktaydı. Hastaların 28 (%53,8) tanesi önceki 1 yıl
içinde hastanede yatış öyküsüne sahipken 24‟ünde (%46,2) önceki 1 yılda yatış öyküsü yoktu.
Ortalama CAT puanı 24,9 ±9,7 ve ortalama CAT doldurma süresi 3,15 dk. idi. Hastaların CAT
skoru incelendiğinde yatan hastaların skoru ayaktan hastalara kıyasla istatistiksel olarak anlamlı
yüksekti (29,73± 8,37 karşı 17,21±
6,80 ve p<0,01). Önceki 1 yıl içerisinde hastanede yatan hastaların ortalama CAT skoru
28,75 ± 10,05 iken önceki 1 yıl içerisinde hastanede yatmamış hastaların ortalama CAT skoru
21,61 ± 10,05 (p<0,01) idi.Aynı şekilde sonraki 3 ay içerisinde hastanede yatma endikasyonu
olmayan hastaların ortalama CAT skoru 22,89 ± 9,8 iken sonraki 3 aylık dönemde hasta yatışı
olan hastaların ortalama CAT değeri 29,87 ± 7,82 idi (p=0,018).Hastaların ortalama CAT
puanı ile diğer dispne ölçütleri kıyaslaması yapıldığında mMRC evre 4 ile evre 5 arasında
istatistiksel anlamlı fark izlendi. SGRQ toplam skorunda 60 puan altı ile 60 ve üzeri puan alanlar
arasında istatistiksel anlamlı fark gözlendi. Aynı şekilde Borg sınıf 1 (Borg1,2,3,4 puanlarından
birini alan grup) ve Borg sınıf 2 (5,6,7 puanlarından birinin alan grup) arasında ve Borg sınıf 2
ile Borg sınıf 3 (Borg 8,9,10 puanlarından birini alan grup) arasında istatistiksel anlamlı fark
izlendi. CAT puanı, SGRQ bölüm ve toplam puanları ve Borg ile mMRC ölçeği arasında pozitif
istatistiksel anlamlı korelasyon saptandı. (p<0,01)
Sonuç: CAT testi KOAH‟ ın her döneminde hastalığın karakteristik ve karmaşık yapısını
gösterebilen kolay, kısa, anlaşılır ve günlük pratikte hasta hekim arasında ki iletişimi sağlayarak
hastaların daha optimum şekilde ele alınmasını sağlayacak, daha önce kullanılan çeşitli
dispne ölçüm testleri ile mükemmel uyumlu bir testtir. Bu testin günümüzde de akciğer
fonksiyon testlerine yardımcı olarak tüm KOAH hastalarında kullanılmasını tavsiye etmekteyiz.

Anahtar sözcük: CAT testi, KOAH, Dispne Ölçüm Skalaları

Abstract:
Aim:Classically pulmonary function tests are used to diagnose, determine the severity and evaluate
treatment response in COPD patients. In many clinical studies a decision is made by assessment of
variation in FEV1 value. However, COPD is an airway flow restriction that is not responded or
partially responded to bronchodilators, so to evaluate the course of the disease the life quality and
symptoms of the patients should also be taken into consideration. In this study, we aimed to compare
the newly defined, targeting to measure the life quality of patient, COPD assessment test (CAT)
with other tests defined before for the same purpose and which are long lasting in daily practice; and
to show the availability of CAT in prediction of early hospital admission of COPD patients.
Materials and method:COPD patients presented to outpatient and inpatient clinic of
NecmettinErbakan University Meram Medical Faculty Pulmonary Medicine Department were
enrolled to the study. Age, file numbers, phone numbers, disease period, COPD stage, smoking
and environmental biomass exposure history, COPD exacerbation and hospitalization history in
the past 1 year period and 3 months period after the test (with the phone calls and hospital records)
and co-morbidities of the patients were recorded. In our clinic pulmonary function test laboratory,
pre-bronchodilator and post-bronchodilator pulmonary function tests were done. In aseptic
conditions, arterial blood gas analysis from radial artery and synchronous digital oxygen saturation
by pulse oximetry were recorded. However, cases using systemic steroid were not included to study.
After these test, in a silent room face to face m MRC, SGRQ and CAT were done with a
chronometry, by the method clinician asking the questions and marking the answers. The patients
were asked to mark the Borg scale after a 10 to 15 minutes of exercise. SGRQ score was measured
in computer.
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Results:Forty eight male(92,3%) and 4 female (7,7%), totally 52 patients were enrolled to the
study. Mean age was 64 ± 9 (40-80). While mean disease time was 10,7 ± 7 (1-30) years, mean
smoking period was (46 patients) 51,8 ±25 (15-150) pack-years. Nineteen (36,5%) of patients
was from outpatient clinic and 33 (63,5%) of them were comprised of patients followed in
inpatient clinic. While, 28 (53,8%) of patients had a history of hospitalization in the past 1 year,
24 (46,2%) of them did not have hospitalization history. Mean CAT score was 24,9 ±9,7 and
mean CAT fill time was 3,15 min.When we evaluate the CAT score of the patients; the score of
inpatient cases were statistically significantly higher that cases compared to outpatient clinic
(29,73± 8,37 versus 17,21± 6,80 and p<0,01). The mean CAT score of cases hospitalized in the
last 1 year was 28,75 ± 10,05 and mean CAT score of cases that were not hospitalized was
21,61 ± 10,05 (p<0,01) . Similarly mean CAT score of cases that were not admitted to hospital
in the 3 months period after the test was 22,89 ± 9,8 and the CAT score of cases hospitalized in
this period was 29,87
±,82 (p=0,018).When we compared the mean CAT scores of the patients and other
dyspnea scales, significant difference was found with mMRC stage 4 and stage 5. In SGRQ total
score significant difference was observed between cases took a score under 60 and a scoreabove
60. Similarly, statistical significant was present between Borg class 1 (group that took the score
of one of Borg 1,2,3 or 4) and Borg class 2 ( group that took the score of one of Borg 5,6 or 7);
and between Borg class 2 and Borg class 3 (group that took the score of one of Borg 8,9 or 10).
Positive statistically significant correlation was found between CAT score, SGRQ division and
total scores and with Borg and mMRCscale (p<0,01).
Conclusion: CAT is a easy, short, understandable test that can show the characteristic and
complex structure of COPD in every stage of the disease and a test that will provide optimum
evaluation of cases by providing the communication between the clinician and patient in daily
practice; and it is excellently compatible with different dyspnea measurement test used before.
We advise to use this test in all COPD patients as a helpful test beside pulmonary function tests
in daily practice.

Key words: CAT test, COPD, DyspneaMeasurementScales