A101-21 The St. George’s Respiratory Questionnaire (SGRQ) and the Chronic Airways Assessment Test (CAAT) in Alpha-1 Antitrypsin Deficiency: Two Tools, One Concept?

Abstract Background The St. George’s Respiratory Questionnaire (SGRQ) is a widely used, validated measure of health-related quality of life (HRQoL) in lung disease. The Chronic Airways Assessment Test (CAAT) is a newer, validated, disease-specific instrument that is considerably shorter and easier to score. While both instruments are used in COPD, their comparability has not been well established in alpha-1 antitrypsin deficiency (AATD). Our study compared the performance and agreement of SGRQ and CAAT in a large cohort of individuals with AATD-associated lung disease. Methods Data from AlphaNet, a US health management organization supporting individuals with AATD and lung disease, were used. Participants were eligible if they completed both SGRQ and CAAT within a 2-year window and consented to research use of their data. Descriptive statistics were summarized using means (SD) and proportions. Associations between SGRQ Total and CAAT were examined using Pearson correlation coefficients. Divergence between the two instruments was evaluated using linear regression, where observations with residuals ≥2 SD from the regression line were defined as discordant. Participants with positive and negative residuals beyond this threshold were compared to identify factors associated with discordant HRQoL assessments. Results Among 2,460 participants (mean age 57.4±10.6 years; 56.2% female), the mean SGRQ Total score was 38.6±18.0, and the mean CAAT score was 16.5±8.1. SGRQ Total and CAAT were strongly correlated (r = 0.69). Domain-level analyses showed the strongest correlation between SGRQ Activity and CAAT items on climbing stairs and household activities (r = 0.62). Discordant scores were observed in 105 participants (4.3%) (Figure 1A). Those with positive residuals (n = 68), where observed SGRQ Total was higher than predicted by the CAAT, had a higher prevalence of mMRC≥2 (79.4%), ≥2 exacerbations in the past year (55.9%), regular use of oxygen (45.8%), and productive cough (56.1%) compared with participants showing negative residuals (n = 37) or concordant results (n = 2,355) (Figure 1B). Conclusion SGRQ and CAAT were strongly correlated in this large cohort of individuals with AATD-associated lung disease, supporting comparability between the instruments. A small subset showed discordant results, where the 2 instruments diverged, reflecting cases where the two instruments diverged in assessing health status. These discrepancies may indicate that SGRQ and CAAT capture both overlapping and distinct aspects of disease impact and symptom burden. Given its brevity and ease of use, CAAT may serve as a practical alternative to SGRQ in AATD. Further work should examine their longitudinal performance and responsiveness to change. This abstract is funded by: AlphaNet, Inc.