classically , copd is defined as chronic progressive airflow limitation that is 
 partially reversible and causes significant extrapulmonary effects , culminating in a 
 reduction in the functional capacity , social interaction , and well - being of the 
 patients , negatively affecting their health - related quality of life 
 ( hrqol ) .
( 


 , 


 ) 
  the literature indicates that the chronic symptoms of copd associated with the 
 systemic manifestations of the disease are the major factors responsible for the 
 worsening of hrqol .
although the airflow obstruction is partially reversible , the 
 disease control interventions are primarily aimed at improving the hrqol of 
 patients , which thereby becomes an important measure to be assessed .
( 


 , 


 ) 
  the administration of questionnaires to assess the hrqol of patients with copd has 
 been widely discussed in the literature .
the results inferred by the use of these 
 instruments generate reliable , valid , and reproducible evidence .
( 


 ) 
  disease - specific questionnaires designed to assess copd impact are widely used in 
 clinical studies . however , these questionnaires are still considered complex and 
 extensive , requiring a substantial amount of time to completion .
chief among them 
 are the saint george 's respiratory questionnaire ( sgrq ) , ( 


 ) the chronic respiratory questionnaire ( crq ) , ( 


 ) the breathing problems questionnaire , ( 


 ) and the airways questionnaire 20 ( aq20 ) , ( 


 ) all of which have been validated for use in brazil .
recently , a group of researchers in the united kingdom developed and validated the 
 copd assessment test ( cat ) , which is a short , simple instrument for quantifying copd 
 impact during routine clinical practice , in addition to aiding health status 
 assessment and facilitating communication between patients and health 
 professionals .
( 


 ) however , this questionnaire has not been validated for use in brazil . 

therefore , the objective of the present study was to validate a portuguese - language 
 version of the cat for use in brazil and to assess the reproducibility of this 
 version .
this was a cross - sectional study , conducted between january and november of 2012 , 
 involving patients treated at the pulmonology outpatient clinic of the federal 
 university of cear walter cantdio university hospital and patients eligible for 
 pulmonary rehabilitation at the dr .
carlos alberto studart gomes messejana hospital , 
 both of which are located in the city of fortaleza , brazil .
the present study was conducted in accordance with brazilian national health council 
 resolution 196/96 , which sets out the ethical principles for human research , and was 
 approved by the ethics committees of the two hospitals ( ruling no .
the inclusion criteria were as follows : having been clinically diagnosed with copd 
 with moderate to severe airflow obstruction and having an fev1/fvc ratio 
 < 0.7 ( as measured by spirometry ) , in accordance with the recommendations of 
 the global initiative for chronic obstructive lung disease ( 


 ) ; being between 40 and 80 years of age ; being clinically stable ( no 
 hospitalizations or infections in the three months prior to the study ) ; and being a 
 smoker or former smoker with a smoking history greater than 10 pack - years .
the exclusion criteria were as follows : experiencing an exacerbation of copd 
 requiring therapeutic intervention ; and having other nonpulmonary diseases that are 
 considered disabling , severe , or difficult - to - control .
the cat consists of eight items , designated cough , phlegm , chest tightness , 
 breathlessness , activity limitations at home , confidence leaving home , sleep , and 
 energy . for each item ,
the patient chooses only one response option , which is scored 
 from zero to five ( appendix 1 ) . at the end of the test
, all response scores are 
 summed , and then the clinical impact of copd is determined on the basis of the 
 stratification scoring of the study that developed and validated the 
 cat .
( 


 ) the results vary according to the range within which the scores 
 obtained lie , being classified by clinical impact as follows : 6 - 10 points , mild ; 
 11 - 20 , moderate ; 21 - 30 , severe ; and 31 - 40 , extremely severe . in order to test the inter - rater reliability of the cat ,
the patients were 
 administered the questionnaire twice by two observers , 30 minutes apart , during the 
 first visit ( v1 ) . the second visit ( v2 )
occurred 7 days after the first one , and the 
 cat was again administered to the same patients by only one of the observers in 
 order to test the intra - rater reliability .
also at baseline , the patients underwent the six - minute walk test ( 6mwt ) and 
 spirometry , as well as being administered the previously validated 
 portuguese - language versions of the sgrq , ( 


 ) hospital anxiety and depression scale ( hads ) , and modified medical 
 research council ( mmrc ) dyspnea scale .
spirometry was performed with a respiradyne ii plus spirometer ( sherwood medical , st . 
 louis , mo , usa ) , in accordance with brazilian guidelines , ( 


 ) using the reference values for the brazilian population established by 
 pereira et al .
( 


 ) 
  the 6mwt was performed in accordance with guidelines established by the american 
 thoracic society , ( 


 ) with the patient being encouraged to walk as far as possible , in six 
 minutes , on a 30-m level corridor . at the end of the test , the examiner recorded the 
 distance covered .
the hads consists of 14 items , of which 7 focus on the assessment of anxiety ( hads - a ) 
 and 7 focus on the assessment of depression ( hads - d ) .
each item can be scored from 
 zero to three , the maximum score on each subscale being 21 points .
we adopted the 
 cut - off points recommended for both subscales : 0 - 8 points , absence of anxiety and/or 
 depression ; and  9 points , presence of anxiety and/or depression .
( 


 ) 
  data were statistically analyzed with the statistical package for the social 
 sciences , version 17.0 ( spss inc . ,
chicago , il , usa ) and graphpad prism , version 6.0 
 ( graphpad software inc . , san diego , ca , usa ) .
for the analysis of the reliability of 
 the administration of the cat ( v1 vs. v2 ) , we used the intraclass correlation 
 coefficient ( icc ) .
the wilcoxon test was used to compare the scores obtained from 
 the administration of the cat by the observer in v1 and v2 . in order to assess the 
 agreement between v1 and v2 , we used bland & altman plots .
the instruments were 
 tested for internal consistency by cronbach 's alpha coefficient . in order to 
 validate the cat , we assessed the correlations ( spearman 's correlation test ) of its 
 scores with those obtained on the sgrq ( gold standard questionnaire ) , hads , and mmrc 
 dyspnea scale , as well as with 6mwd and spirometry values .
the study sample comprised 50 patients with copd , 26 of whom were female ( 52% ) .
the 
 mean age of the patients was 62.2  8.4 years , whereas the mean height and weight 
 were 1.58  0.08 cm and 65.8  15.9 kg , respectively ( table 1 ) . 

table 1 characteristics of the sample of 50 copd patients studied.a 
  there were no significant differences between the total scores obtained from the 
 administration of the cat by the same observer in v1 and v2 ( 20.7  9.8 vs. 20.1  
 9.4 ; p = 0.8 ) .
the icc for intra - rater reliability ( v1 vs. v2 ) was 0.96 ( 95% ci : 
 0.93 - 0.97 ) . there were also no significant differences in the scores between the two observers of 
 the study ( 20.7  8.5 vs. 21.2  9.0 ; p = 0.4 ) .
the icc for inter - rater reliability 
 was 0.98 ( 95% ci : 0.96 - 0.98 ) . the cronbach 's alpha coefficient for the cat was 0.98 
 ( p < 0.001 ) .
bland altman plots showed good test - retest reliability and good inter - rater 
 reliability ( figure 1 ) . 

figure 1 bland & altman plots . in a , intra - rater analysis : mean = 0.64 ; 
 upper limit ( ul ) = 5.69 and lower limit ( ll ) = 4.41 . in b ,
inter - rater 
 analysis : mean = 0.26 ; ul = 4.80 and ll = 5.32 . 
 
there were significant correlations between the cat score and the sgrq total and 
 domain scores ( 0.51 < r < 0.64 ) .
the cat score correlated better with the 
 mmrc dyspnea scale score than with the hads - d score ( r = 0.48 vs. r = 0.39 ; p < 
 0.05 for both ) .
the cat scores correlated negatively with 6mwd ( r = 0.37 ) and with 
 some pulmonary function measurements , such as fev1 in l ( r = 0.38 ) ; fvc 
 in l ( r = 0.39 ) ; and fvc as % of the predicted value ( r = 0.30 ; table 2 ) . 

table 2 correlations ( spearman 's correlation test ) of the copd assessment 
 test scores with the saint george 's respiratory questionnaire scores , 
 spirometry values , six - minute walk distance , modified medical research 
 council dyspnea scale scores , and hospital anxiety and depression scale 
 scores . 
 
the present study showed that the portuguese - language version of the cat had 
 excellent reliability when administered by different observers and when administered 
 by the same observer at two distinct time points .
bland altman plots showed that the 
 cat has good test - retest reliability , as well as a high cronbach 's alpha coefficient 
 and a good correlation with the sgrq ( total and domain scores ) .
the process of development and preparation of the cat arose from the need for new 
 instruments for evaluating copd impact on hrqol and clinical practice in a simple , 
 fast , and effective way .
( 


 ) 
  various studies conducted in countries such as spain , ( 


 ) china , ( 


 ) south korea , and saudi arabia ( 


 , 


 ) have validated versions of the cat in their language and reported the 
 instrument to have good reproducibility .
we found no studies validating a 
 portuguese - language version of the cat for use in brazil or assessing the 
 reproducibility of the cat . during test - retest
jones et al . ( 


 ) found high icc values and high cronbach 's alpha coefficients when they 
 performed the first validation of the cat in a multicenter study .
the cronbach 's 
 alpha coefficient of 0.98 found in the present study shows that the questionnaire 
 has excellent internal consistency .
the questionnaires used for the validation of the cat were the sgrq , mmrc dyspnea 
 scale , and hads .
these instruments were used because they are related to some 
 specific items of the cat , such as those concerning respiratory symptoms and 
 limitations in activities of daily living ( which are also addressed in the sgrq and 
 mmrc dyspnea scale ) and those concerning self - confidence and energy ( which are also 
 addressed in the hads and sgrq ) . in general , there were high and significant correlations between the cat scores and 
 the sgrq total and domain scores .  
previous studies have demonstrated that the cat can measure the impact of copd on the 
 lives of patients , showing correlations with standard questionnaires other than the 
 sgrq , such as the crq and the clinical copd questionnaire .
( 


 - 


 ) 
  regarding the pulmonary function variables , the present study showed that there was a 
 weak but significant correlation of the cat scores with some spirometry values and 
 6mwd .
this might represent a discrepancy between patient experiences and 
 perspectives and the degree of respiratory dysfunction .
other studies have also 
 shown weak correlations between the cat scores and pulmonary function values , 
 especially fev1 .
( 


 , 


 , 


 , 


 ) 
  regarding the sensation of dyspnea , the cat scores correlated significantly with mmrc 
 dyspnea scale scores and sgrq symptom scores , showing that the cat can detect the 
 patient 's respiratory complaints . there was no significant correlation between the cat scores and the anxiety scores . 

this might 
 have occurred because , among the cat questions , only the items concerning energy and 
 confidence leaving home address issues that are more directly related to the 
 psychological component of the patient .
the administration time of the cat in the present study was , on average , 104 s ; this 
 occurred because of the simplicity of the questions and response options . while 
 administering the cat to patients with copd , ringbaek et al .
( 


 ) found that it required a shorter administration time than did the sgrq 
 and crq ( 107 s , 134 s , and 578 s , respectively ) .
there was no back - translation analysis of the cat , since there is already a 
 portuguese - language version , written in congruent , easy - to - understand language , 
 ready for use .
none of the items in the present version sounded odd in brazilian 
 portuguese or seemed to be alien to the brazilian culture and society , and therefore 
 there was no need for any significant adaptations . since the present study was cross - sectional in design , it was not possible to 
 evaluate the responsiveness of the portuguese - language version of the cat to 
 interventions , such as pulmonary rehabilitation .
this can be considered a limitation 
 of the study ; however , other studies have used the same approach .
( 


 , 


 , 


 , 


 ) following this line of thought and knowing that the portuguese - language 
 version of the cat proved to be valid and reproducible , we believe that , in future 
 studies , it will prove to be responsive
. in conclusion , the portuguese - language version of the cat is a valid , reproducible , 
 and reliable instrument for assessing the impact of copd on the lives of patients in 
 brazil .
  realizar a validao e verificar a reprodutibilidade da verso em portugus 
 do brasil do copd assessment test ( cat ) .
  estudo multicntrico , no qual foram selecionados pacientes com dpoc estvel 
 em dois hospitais de ensino na cidade de fortaleza , ce .
a verso do cat foi 
 aplicada duas vezes a 50 pacientes com dpoc por dois observadores 
 independentes no mesmo dia .
aps uma semana , esse mesmo questionrio foi 
 aplicado novamente aos mesmos pacientes por um dos observadores .
no primeiro 
 dia , os pacientes foram submetidos  prova de funo pulmonar e ao teste de 
 caminhada de seis minutos ( tc6 ) e responderam as verses validadas de 
 qualidade de vida relacionada  sade ( qvrs ) .
( sgrq ) , escala de dispneia 
 modified medical research council ( mmrc ) e 
 hospital anxiety and depression scale ( hads ) .
  as reprodutibilidades interobservador e intraobservador foram excelentes 
 ( coeficiente de correlao intraclasse [ cci ] = 0,96 ; ic95% : 0,93 - 0,97 ; p 
 <
0,001 ; e cci = 0,98 ; ic95% : 0,96 - 0,98 ; p < 0,001 , 
 respectivamente ) . as disposies grficas de bland altman demonstraram boa 
 confiabilidade teste - reteste .
houve correlaes significativas do escore 
 total do cat com os resultados de espirometria , tc6 , sgrq , escala de 
 dispneia mmrc e hads - depresso .
  a verso brasileira do cat  um instrumento vlido , reprodutvel e confivel 
 para a avaliao dos pacientes com dpoc na populao brasileira .
a dpoc  conceituada classicamente como uma limitao crnica e progressiva ao 
 fluxo de ar , parcialmente reversvel , que ocasiona efeitos extrapulmonares 
 significantes , o que culmina na reduo da capacidade funcional , socializao e 
 bem - estar desses pacientes , influenciando negativamente a qualidade de vida 
 relacionada  sade ( qvrs).(1,2 ) a literatura aponta que os sintomas crnicos da dpoc associados s manifestaes 
 sistmicas da doena so os principais responsveis pela piora da qvrs .
apesar 
 de o quadro de obstruo ao fluxo de ar ser parcialmente reversvel , as 
 intervenes para o controle da doena so principalmente destinadas  melhora 
 da qvrs dos pacientes , tornando - se assim uma importante medida a ser 
 avaliada .
( 


 , 


 ) 
  a aplicao de questionrios para avaliar a qvrs de pacientes com dpoc j foi 
 amplamente discutida na literatura .
os resultados inferidos pela utilizao 
 desses instrumentos geram evidncias confiveis , vlidas e 
 reprodutveis .
( 


 ) 
  os questionrios especficos para a avaliao do impacto da dpoc so bastante 
 utilizados em estudos clnicos ; porm , ainda so considerados complexos e 
 extensos , demandando uma quantidade maior de tempo para que sejam respondidos . 

dentre eles , destacam - se o saint george 's respiratory questionnaire ( sgrq , 
 questionrio do hospital saint george na doena respiratria ) , ( 


 ) chronic respiratory questionnaire ( crq ) , ( 


 ) questionrio para problemas respiratrios , ( 


 ) e airways questionnaire 20 ( aq20 , questionrio de vias areas 
 20),todos j validados no brasil .
recentemente foi desenvolvido e validado para a lngua inglesa o copd assessment 
 test ( cat ) , que tem como caracterstica ser um instrumento curto e simples para 
 a quantificao do impacto dos sintomas da dpoc na prtica clnica rotineira , 
 alm de auxiliar na avaliao do estado de sade e facilitar a comunicao entre 
 o paciente e os profissionais de sade.entretanto , esse 
 questionrio ainda no conta com uma verso validada para uso no brasil .
dessa 
 forma , o objetivo do presente estudo foi realizar a validao e verificar a 
 reprodutibilidade da verso em portugus do brasil do cat .
foi realizado um estudo do tipo transversal com pacientes atendidos no 
 ambulatrio de pneumologia do hospital universitrio walter cantdio da 
 universidade federal do cear e com pacientes candidatos  reabilitao pulmonar 
 do hospital de messejana dr .
carlos alberto studart gomes , localizados na cidade 
 de fortaleza ( ce ) , no perodo entre janeiro e novembro de 2012 . o presente estudo seguiu os preceitos ticos segundo a resoluo 196/96 do 
 conselho nacional de sade , que estabelece os princpios ticos para as 
 pesquisas em seres humanos , sendo aprovado pelos comits de tica dos dois 
 hospitais ( parecer n 108.10/11 e parecer n 880/12 , respectivamente ) .
todos 
 os pacientes deram consentimento formal para sua participao no estudo ao 
 assinarem o termo de compromisso esclarecido antes de sua incluso . preencheram os critrios de incluso os pacientes com diagnstico clnico de dpoc 
 com obstruo ao fluxo de ar de moderada a grave , apresentando valores 
 espiromtricos da relao vef1/cvf < 0,7 , conforme as 
 recomendaes da global initiative for chronic obstructive lung 
 disease ( 


 ) ; idade entre 40 e 80 anos ; estveis clinicamente ( ausncia de 
 episdio de internao ou infeco nos trs meses anteriores  realizao do 
 estudo ) ; e fumantes ou ex - fumantes com histria de carga tabgica acima de 10 
 anos - mao . foram considerados como critrios de excluso a presena de exacerbao de dpoc 
 que necessitasse de interveno teraputica e presena de outras doenas no 
 pulmonares consideradas incapacitantes , graves ou de difcil controle .
o cat  composto de oito itens , denominados tosse , catarro , aperto no peito , 
 falta de ar , limitaes nas atividades domiciliares , confiana em sair de casa , 
 sono e energia .
para cada item , o paciente escolhe apenas uma opo de resposta , 
 cuja pontuao varia de zero a cinco ( anexo 1 ) .
ao final do teste , soma - se a 
 pontuao de todas as respostas e , assim , avalia - se o impacto clnico da dpoc 
 conforme a pontuao de estratificao do estudo de desenvolvimento e validao 
 do cat .
( 


 ) os resultados variam de acordo com a faixa dos escores obtidos , 
 classificados da seguinte forma em relao ao impacto clnico : 6 - 10 pontos , 
 leve ; 11 - 20 , moderado ; 21 - 30 , grave ; e 31 - 40 , muito grave .
para a avaliao da reprodutibilidade interobservador do cat , os pacientes 
 completaram duas vezes o questionrio por dois examinadores em um intervalo de 
 30 minutos durante a primeira visita ( v1 ) .
a segunda visita ( v2 ) foi realizada 7 
 dias aps a primeira , sendo o cat aplicado novamente aos mesmos pacientes por 
 somente um dos examinadores para a avaliao da reprodutibilidade 
 intraobservador .
ainda no primeiro dia , os pacientes foram submetidos ao sgrq , j traduzido e 
 validado no brasil , ( 


 ) teste da caminhada de seis minutos ( tc6 ) , espirometria , hospital 
 anxiety and depression scale ( hads , escala hospitalar de ansiedade e depresso ) 
 e modified medical research council ( mmrc , escala modificada do 
 medical research council ) .
a espirometria foi realizada com um aparelho respiradyne ii plus ( sherwood 
 medical , st .
louis , mo , eua ) e seguiu as normas de diretrizes 
 brasileiras , ( 


 ) sendo utilizados como valores de referncia para a populao 
 brasileira aqueles encontrados no estudo de pereira et al . ( 


 ) 
  o tc6 foi realizado conforme as orientaes estabelecidas pela american thoracic 
 society , ( 


 ) sendo o paciente estimulado a caminhar a mxima distncia possvel 
 em um corredor de superfcie plana com 30 m de comprimento por um perodo de 
 seis minutos . ao final do teste , o examinador registrou a distncia 
 percorrida . a hads  composta de 14 itens , dos quais 7 so voltados para a avaliao da 
 ansiedade ( hads - a ) e 7 , para a depresso ( hads - d )
. cada um dos seus itens pode 
 ser pontuado de zero a trs , compondo uma pontuao mxima de 21 pontos para 
 cada escala .
foram adotados os pontos de cortes recomendados para ambas as 
 subescalas : 0 - 8 pontos , ausncia de ansiedade e / ou depresso ; e  9 pontos , 
 presena de ansiedade e / ou depresso .
( 


 ) 
  a dispneia foi avaliada por meio da escala mmrc . ( 


 ) 
  os dados obtidos foram analisados estatisticamente atravs dos programas 
 statistical package for the social sciences , verso 17.0 ( spss inc . ,
chicago , 
 il , eua ) e graphpad prism , verso 6.0 ( graphpad software inc . , san diego , ca , 
 eua ) .
para a anlise da reprodutibilidade da aplicao do cat ( v1 vs. v2 ) , foi 
 utilizado o coeficiente de correlao intraclasse ( cci ) .
o teste de wilcoxon foi 
 utilizado para comparar os escores obtidos na aplicao do cat pelo examinador 
 na v1 e v2 . a concordncia entre a v1 e a v2 foi avaliada
a consistncia interna dos instrumentos foi avaliada 
 por meio do coeficiente alfa de cronbach .
para a validao do cat , foi avaliada 
 a correlao de spearman de seus resultados com os obtidos no sgrq ( questionrio 
 padro ouro ) , tc6 , espirometria , hads e mmrc .
participaram do estudo 50 pacientes com dpoc , sendo 26 do sexo feminino ( 52% ) . a 
 mdia de idade dos pacientes foi de 62,2  8,4 anos , enquanto as mdias de 
 altura e de peso foram de 1,58  0,08 cm e 65,8  15,9 kg , respectivamente 
 ( tabela 1 ) . 
 tabela 1 caracterizao da amostra de 50 pacientes com dpoc 
 estudados.a 
  na comparao da pontuao total obtida entre a aplicao e a reaplicao do cat 
 ( v1 e v2 ) por um mesmo observador , no foram observadas diferenas 
 significativas ( 20,7  9,8 vs. 20,1  9,4 ; p = 0,8 ) .
o cci intraobservador entre 
 v1 e v2 foi de 0,96 ( ic95% : 0,93 - 0,97 ) .
quando comparada a pontuao entre os dois examinadores do estudo , tambm no 
 houve diferena significativa ( 20,7  8,5 vs. 21,2  9,0 ; p = 0,4 ) .
o coeficiente alfa de cronbach 
 do cat foi de 0,98 ( p < 0,001 ) .
em relao  concordncia das pontuaes do cat obtidas pelos dois examinadores 
 por meio da anlise da disposio grfica de bland altman , evidenciou - se uma boa 
 concordncia entre a aplicao e a reaplicao do questionrio , assim como na 
 comparao das pontuaes entre os dois observadores ( figura 1 ) . 

em a , anlise 
 intraobservador : mdia = 0,64 ; limite superior ( ls ) = 5,69 e limite 
 inferior ( li ) = 4,41
. em b , anlise interobservador : mdia = 0,26 ; 
 ls = 4,80 e li = 5,32 . 
 
foram observadas correlaes significativas do cat com o escore total e os 
 domnios do sgrq ( 0,51 < r < 0,64 )
. o cat apresentou uma correlao 
 melhor com a escala mmrc do que com hads - d ( r = 0,48 vs. r = 0,39 ; p < 0,05 
 para ambos ) .
houve uma correlao negativa do cat com o tc6 ( r = 0.37 ) e com 
 algumas medidas de funo pulmonar , tais como vef1 em l ( r = 0,38 ) ; 
 cvf em l ( r = 0,39 ) ; e cvf em % do previsto ( r = 0,30 ; tabela 2 ) . 

tabela 2 coeficientes de correlao de spearman dos escores obtidos no 
 teste de avaliao da dpoc com os resultados do saint george 's 
 respiratory questionnaire , valores espiromtricos , distncia 
 percorrida no teste de caminhada de seis minutos , escala modified 
 medical research council e hospital anxiety and depression 
 scale . 
 
o presente estudo mostrou que a verso brasileira do cat apresentou excelente 
 confiabilidade tanto em sua aplicao por diferentes observadores quanto em sua 
 aplicao por um mesmo observador em dois momentos .
observada uma boa 
 concordncia a partir das disposies grficas de bland altman entre as 
 aplicaes intra e interobservador do cat , alm de um elevado coeficiente alfa 
 de cronbach e uma boa correlao com os diferentes domnios e escore total do 
 sgrq .
o processo de desenvolvimento e elaborao do cat surgiu a partir da necessidade 
 de novos instrumentos que avaliassem de forma simples , rpida e efetiva o 
 impacto da dpoc na qvrs e na prtica clnica . ( 


 ) 
  diversos estudos em pases como espanha , ( 


 ) china , ( 


 ) coreia do sule arbia saudita ( 


 , 


 ) j realizaram o processo de validao do cat e verificaram uma boa 
 reprodutibilidade do questionrio .
durante a aplicao e a reaplicao do questionrio , o cci observado foi de 0,98 . 

jones et al.encontraram valores elevados para o cci e 
 coeficiente alfa de cronbach ao realizarem a primeira validao do cat em um 
 estudo multicntrico .
o coeficiente alfa de cronbach de 0,98 , observado no 
 presente estudo , revela que o questionrio apresenta uma excelente consistncia 
 interna .
os questionrios / escalas utilizados para a validao do cat foram o sgrq , mmrc e 
 hads .
esses instrumentos foram utilizados porque esto relacionados a algumas 
 perguntas especficas do cat , tais como sintomas respiratrios , limitao nas 
 atividades da vida diria ( itens tambm abordados no sgrq e mmrc ) , autoconfiana 
 e disposio ( itens tambm abordados no hads e sgrq ) . de um modo geral , houve correlaes elevadas e significantes do cat com os 
 domnios e o escore total do sgrq
. estudos anteriores j demonstraram que o cat  capaz de mensurar o impacto da 
 dpoc na vida dos pacientes , sendo evidenciadas correlaes com outros 
 questionrios padres alm do sgrq , tais como o crq e clinical copd 
 questionnaire .
( 


 - 


 ) 
  quanto s variveis de avaliao da funo pulmonar , o presente estudo mostrou 
 uma correlao fraca , porm significativa , do cat com alguns valores de 
 espirometria e tc6 .
esse fato pode refletir a discrepncia entre as experincias 
 e perspectivas do paciente e o seu grau de disfuno respiratria .
outros 
 estudos tambm evidenciaram a fraca correlao do cat com a funo pulmonar , 
 principalmente com o vef1 .
( 


 , 


 , 


 , 


 ) 
  quanto  avaliao da sensao de dispneia , houve correlaes significativas do 
 cat com a escala mmrc e com o domnio sintomas do sgrq , mostrando que o cat  
 capaz de captar as queixas respiratrias dos indivduos .
isso pode 
 ter ocorrido porque , entre as questes do cat , apenas os itens autoconfiana e 
 energia abordam questes mais direcionadas para o componente psicolgico do 
 paciente .
o tempo de aplicao do cat na presente pesquisa foi , em mdia , de 104 s ; isso 
 ocorreu pela simplicidade das questes e de opes de respostas .
( 


 ) ao aplicarem o cat  pacientes com dpoc , observaram um tempo de 
 resposta mais rpido quando comparado ao tempo de aplicao do sgrq e crq ( 107 
 s , 134 s e 578 s ; respectivamente ) .
uma avaliao da retraduo do cat para o ingls , pois j 
 existe uma verso em portugus com linguagem harmnica , de fcil compreenso e 
 pronta para ser preenchida .
nenhum item na presente verso apresentou 
 discordncia com a lngua portuguesa ou com a realidade cultural e social do 
 brasil , e , por isso , no houve necessidade de adaptaes importantes .
como o presente estudo  de tipo transversal , no foi possvel avaliar a 
 responsividade da verso em portugus do cat a intervenes , como , por exemplo , 
  reabilitao pulmonar .
esse fato pode ser considerado como uma limitao do 
 estudo ; porm , outros estudos j demonstraram essa abordagem .
( 


 , 


 , 


 , 


 ) seguindo essa linha de pensamento e sabendo - se que a verso em 
 portugus mostrou - se vlida e reprodutvel , acredita - se que , em futuros estudos , 
 ela se mostre responsiva .
concluindo , a verso brasileira do cat  vlida , reprodutvel e confivel quanto 
  avaliao do impacto da dpoc na vida dos pacientes .
 objective : to validate a portuguese - language version of the copd assessment test ( cat ) 
 for use in brazil and to assess the reproducibility of this version . 
 methods : this was multicenter study involving patients with stable copd at two 
 teaching hospitals in the city of fortaleza , brazil . 
 two independent 
 observers ( twice in one day ) administered the portuguese - language version of 
 the cat to 50 patients with copd . 
 one of those observers again administered 
 the scale to the same patients one week later . at baseline , 
 the patients 
 were submitted to pulmonary function testing and the six - minute walk test 
 ( 6mwt ) , as well as completing the previously validated portuguese - language 
 versions of the saint george 's respiratory questionnaire ( sgrq ) , modified 
 medical research council ( mmrc ) dyspnea scale , and hospital anxiety and 
 depression scale ( hads ) . 
 results : inter - rater and intra - rater reliability was excellent ( intraclass correlation 
 coefficient [ icc ] = 0.96 ; 95% ci : 0.93 - 0.97 ; p < 0.001 ; and icc = 0.98 ; 
 95% ci : 0.96 - 0.98 ; p < 0.001 , respectively ) . 
 bland altman plots showed 
 good test - retest reliability . 
 the cat total score correlated significantly 
 with spirometry results , 6mwt distance , sgrq scores , mmrc dyspnea scale 
 scores , and hads - depression scores . 
 conclusions : the portuguese - language version of the cat is a valid , reproducible , and 
 reliable instrument for evaluating patients with copd in brazil . 
Introduction
Methods
Results
Discussion
OBJETIVO:
 MTODOS:
RESULTADOS:
CONCLUSES:
Introduo
Mtodos
Resultados
Discusso