B44-15 Performance of the Chronic Airways Assessment Test (CAAT) in Alpha-1 Antitrypsin Deficiency and Predictors of Worse Health Status

Background The Chronic Airways Assessment Test (CAAT) is a brief, validated, self-administered 8-item questionnaire widely used in COPD to evaluate disease impact on health status. The CAAT is broadly applied in both clinical practice and research settings in the COPD population. Our study aimed to examine the performance of the CAAT instrument in a large cohort of individuals with alpha-1 antitrypsin deficiency (AATD)-associated lung disease and identify factors associated with worse health status. Methods We analyzed data from AlphaNet, a US-based health management organization supporting individuals with AATD and lung disease. Participants who completed the CAAT, provided demographic and health data, and consented to research were included. Descriptive statistics were summarized as means (SD) and proportions. Participants were categorized into two groups: CAAT <10 (low impact) and CAAT ≥10 (moderate to very high impact). Group differences were assessed using t-tests and chi-square tests. Clinically relevant or statistically significant variables from bivariate analyses were entered into a multivariable logistic regression model to identify predictors of CAAT ≥10. Results The analytic sample included 759 participants (mean age 60.7±12.3 years; 51.4% female); 46% had a ZZ, ZNull, or NullNull genotype. The mean CAAT score was 16.7±8.8, and 55% had dyspnea with mMRC ≥2. Overall, 23% of participants had CAAT <10 and 77% had CAAT ≥10. Compared with the CAAT <10 group, those with CAAT ≥10 were more likely to report regular oxygen use, two or more exacerbations in the past year, higher mMRC scores, and daily productive cough (all p < 0.0001). In contrast, the CAAT <10 group included a higher proportion of males and never-smokers. In multivariable analysis, significantly higher odds of CAAT ≥10 (vs. CAAT <10) were observed in females, ever-smokers, individuals reporting daily cough with sputum, those with regular oxygen use, and those with ≥2 exacerbations compared with none (Figure 1). Because of its strong correlation with CAAT, mMRC was not included in the multivariable analysis. Conclusion The CAAT demonstrated performance in AATD-associated lung disease consistent with findings in COPD, showing strong associations with exacerbations, dyspnea, and pulmonary symptoms. These results support the use of CAAT as a practical tool for capturing disease impact and identifying patients at risk of poor health status in clinical and research settings.