Chronic Obstructive Pulmonary Disease: Open Access

The Global Initiative for the Diagnosis, Management and Prevention of Chronic obstructive pulmonary disease (COPD) indicates that one key treatment goal is the reduction of the level of respiratory symptoms [1]. To assess this level, GOLD recommends the use of validated questionnaires such as the mMRC questionnaire, the health-related quality of life (HRQoL) Saint George Respiratory Questionnaire (SGRQ) and the COPD Assessment Test (CAT) [2,3]. Because the latter is simpler and shorter, it can be easily implemented in clinical practice.

CAT has now been translated and validated in over 60 languages and dialects throughout the world, including Spanish [3,4]. It has also been used in usual clinical practice studies that allowed the assessment of therapeutic interventions on the progression of COPD [5]. Some regions in Spain (Catalonia, Galicia and Basque Country) have their own languages (different from Spanish) [6-10] and a high percentage of bilingual population that prefer to use them. Thus, it was important to provide clinicians in these Spanish regions with a CAT questionnaire translated in these regional languages for a better assessment of their patients with COPD. Furthermore, a simple translation of the original Spanish questionnaire can lead to misinterpretation due to cultural and language differences which, in turn, can lead to misunderstandings and produce unreliable or invalid results that limit the comparison between populations and cause classification errors in the screening of patients [1].

Hence, our study aimed at demonstrating linguistic equivalence between the validated Spanish CAT questionnaire and the Catalan (CAT-C), Galician (CAT-C) and Basque (CAT-E) versions of CAT. Main results have been published elsewhere [11] and showed excellent linguistic equivalence between them. Levels of concordance for the individual items between them were also good. In terms of validity, there was a good correlation between the scores of each translated version and the Spanish version3, which are also validated and equivalent to the original English version [2]. The psychometric characteristics of these three new versions of CAT were very similar to those obtained from the Spanish version and the original CAT in English, and clearly higher than the accepted threshold for this type of instruments [12], confirming its reliability. Comparing with SGRQ, also administered in this study to assess the convergent validity, results showed that scores of all CAT versions correlated significantly with all dimensions of the SGRQ [11].

Albeit bilingual individuals can adopt and understand concepts, values and expectations in two languages, they represent a special population whose responses should not be automatically extrapolated to those of a monolingual population [13]. Having the CAT questionnaire in Catalan, Galician and Basque, patients will be able to express themselves in the language in which they feel most comfortable. This reduces the possible interpretation bias that the use of questionnaires written in a non-native language can mean for the respondent and helps to improve the doctor-patient interaction.

Disclosures

AA has participated in advisory boards for GSK, Novartis, Chiesi, Almirall, Takeda and Roche. The institution of AA receives subsidies from GSK and Almirall. AA has received payments for conferences including its participation in boards of GSK, Novartis, Chiesi, Almirall, Takeda and Astra-Zeneca. BV is an employee of GSK and hold shares in GSK.

This study was funded by GlaxoSmithKline. (Study number: 113047).

References

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9. https://www.ige.eu/web
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