Background: Patient-reported data can be a useful component in assessing exacerbation risk. The choice of instrument is critical to routine clinical care; the Chronic Airways Assessment Test (CAAT) and Respiratory Symptoms Questionnaire (RSQ) offer patients ease of use.

Aim: To evaluate the association between CAAT and RSQ scores and exacerbation risk in NOVELTY (NCT02760329), a global cohort of patients recruited from routine care settings.

Methods: Patients in NOVELTY with physician-assigned COPD, who had completed the CAAT and RSQ at baseline, and had exacerbation data during Year 1 (Y1) were included. Negative binomial regression models adjusted for key covariates inclusive of age, sex, smoking status, baseline CAAT or RSQ score (and prior exacerbation history in sensitivity models) estimated risk of exacerbation at Y1 in association with the baseline questionnaire scores.

Results: 2,087 patients with COPD were included. A 2-point (assumed minimum clinically important difference) increase in baseline CAAT score was associated with a 7% increase in 1-year exacerbation risk (adjusted relative risk [aRR] [95% CI] 1.07 [1.05, 1.10]) and a 5% increase when exacerbation history was considered (aRR 1.05 [1.02, 1.07]). A 1-point increase in baseline RSQ score was associated with a 7% increase in 1-year exacerbation risk (aRR 1.07 [1.05, 1.10]) and a 5% increase when exacerbation history was considered (aRR 1.05 [1.03, 1.07]).

Conclusion: In patients with COPD in a real-world setting, higher symptom burden was associated with a greater risk of exacerbations, irrespective of prior events. When optimising treatment, clinicians should consider patient-reported symptom control in addition to previous exacerbations.