Cross-sectional validation of the COPD Assessment Test (CAT) among chronic obstructive pulmonary disease patients in rural Uganda

Charles Batte; Andrew Weil Semulimi; Ronald Kasoma Mutebi; Nelson Twinamasiko; Sarah Racheal Muyama; John Mukisa; Immaculate Atukunda; David Mukunya; Robert Kalyesubula; Siddharthan Trishul; Bruce Kirenga

doi:10.1371/journal.pgph.0002013

Cross-sectional validation of the COPD Assessment Test (CAT) among chronic obstructive pulmonary disease patients in rural Uganda

PLOS Glob Public Health. 2023 Jun 5;3(6):e0002013. doi: 10.1371/journal.pgph.0002013. eCollection 2023.

Authors

Charles Batte^{1

2}, Andrew Weil Semulimi^{1

3}, Ronald Kasoma Mutebi^{1

4

5}, Nelson Twinamasiko^{1

4}, Sarah Racheal Muyama¹, John Mukisa⁶, Immaculate Atukunda⁷, David Mukunya⁸, Robert Kalyesubula^{3

9}, Siddharthan Trishul¹⁰, Bruce Kirenga^{1

11}

Affiliations

¹ Department of Medicine, Lung Institute, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
² Climate Change and Health Unit, Tree Adoption Uganda, Kampala, Uganda.
³ Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda.
⁴ Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Ugand.
⁵ Department of Medicine, Mengo Hospital, Kampala, Uganda.
⁶ Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Kampala, Uganda.
⁷ Department of Ophthalmology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
⁸ Faculty of Health Sciences, Department of Community and Public Health, Busitema University, Mbale, Uganda.
⁹ African Community Centre for Social Sustainability (ACCESS), Nakaseke, Uganda.
¹⁰ Division of Pulmonary, Allergy, Critical Care, and Sleep, Miller School of Medicine, University of Miami, Miami, Florida, United States of America.
¹¹ Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.

Abstract

Measuring quality of life is a key component in the management of Chronic Obstructive Pulmonary Disease (COPD). The COPD assessment test (CAT), an easy to administer and shorter instrument than the standard Saint George's respiratory questionnaire (SGRQ), could be an alternative tool for measuring the quality of life of COPD patients in rural Uganda. A cross-sectional study was conducted between June and August 2022, consecutively recruiting 113 COPD patients aged > 40 years from the Low-Dose Theophylline for the management of Biomass-associated COPD (LODOT-BCOPD) study. Upon obtaining consent, participants answered an interviewer administered social demographic, CAT and SGRQ questionnaire. Internal consistency for both SGRQ and CAT was determined using Cronbach's alpha coefficient and values > 0.7 were considered acceptable while correlations were determined using Spearman's rank correlation. Limits of Agreement were visualised using Bland Altman and pair plots. Of the 113 participants, 51 (45.1%) were female. The mean age was 64 ± 12 years, 19 (16.8%) had history of smoking while majority (112 (99.1%)) reported use of firewood for cooking. There was a strong correlation of 0.791 (p < 0.001) between the CAT and SGRQ total scores with a high internal consistency of CAT, Cronbach's alpha coefficient of 0.924 (0.901-0.946). The agreement between the absolute CAT scores and the SGRQ scores was good with a mean difference of -0.932 (95% Confidence Interval: -33.49-31.62). In summary, CAT has an acceptable validity and can be used as an alternative to the SGRQ to assess the quality of life of COPD patients in rural Uganda.

Copyright: © 2023 Batte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

The study was funded through the American Thoracic Society 2021 MECOR Research Award (awarded to CB) and the Makerere University Non-Communicable Diseases (MAKNCD) Research Training Program: supported by the Fogarty International Center of the National Institutes of Health under Award Number D43TW011401 (awarded to BK and WC). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Health or the American Thoracic Society. CB, AWS, RKM, NT, SRM, JM and DM received salary from the MECOR 2021 Research award. CB and BK receive salary from the Makerere University Non-Communicable Diseases (MAKNCD) Research Training Program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.