ABCD Assessment Tool Part 1: What Is It?

Every few years, the GOLD COPD Guidelines are updated. The 2011 update added what is called an ABCD Assessment Tool.¹ This tool was updated in 2017. So, what is this new tool? How might it help you? Here’s what to know.

What is the ABCD Assessment Tool?

According to the guidelines, your doctor must first diagnose you with asthma. This is best done by having you perform a PFT Test. Your doctor doesn’t have to order a PFT. A diagnosis can be made by your symptoms and history alone. But, according to the guidelines, having you do a PFT is the best way of getting to a correct diagnosis.

PFT results can be used to diagnose COPD. They can help your doctor determine what “COPD Stage” you are in. This gives your doctor a number (1, 2, 3, or 4). One is mild COPD and 4 is very severe. This basically tells your doctor how much lung function you have left. It gives you and your doctor a real-life picture of where you stand.^1-2

From there, the next step is to determine a letter: A, B, C, or D. This is determined by using a three-dimensional tool called the ABCD Assessment Tool. It’s neat because, rather than just looking at a number, it allows your doctor to consider the whole patient. It helps your doctor see how airflow limitation affects you on a day to day basis. It helps your doctor determine how you are doing on a day to day basis.^1-2

How does this new tool work?

First, your doctor looks at your history. What is looked at here is your exacerbation (flare-up) history. This is easy to determine. Basically, it’s how many flare-ups you’ve had in the past year. Also looked at is how many of these flare-ups required hospitalizations. So, your “Exacerbation History” helps determine your “Risk” for future flare-ups.^1-3

Second, your doctor will assess your symptoms. Here you will fill out a questionnaire or survey. You will complete one of the following.

Modified British Medical Research Council (mMRC) Questionaire. It’s a 0-4 scale of how short of breath you are on a day to day basis. It also shows how this “breathlessness” affects your ability to stay active. Basically, you just circle one of the following numbers.^1-3

• 0. I feel short of breath only with strenuous exercise
• 1. I feel short of breath when hurrying on level ground or walking up a slight hill
• 2. I have to walk slower than other people of the same age because I feel short of breath. I have to stop to catch my breath when walking at my own pace
• 3. I have to stop to catch my breath after walking 100 yards or after a few minutes
• 4. I feel too short of breath to leave my house. I feel breathless when dressing.

It basically helps your doctor determine how much “functional impairment” you have on a day to day basis.³

COPD Assessment Test (CAT). It’s a scale that goes well beyond just the symptoms of shortness of breath. It lists all the potential symptoms of COPD. Then it has you rate how much those symptoms impair you on a day to day basis. Here’s an example.

• Cough. Rate how much you cough on a scale of 0-5. Zero you don’t cough at all. Five means you cough all the time.
• Phlegm. Rate how much phlegm your lungs produce on a daily basis. Zero means no phlegm at all. Five means you produce lots of phlegm.

Listed here are just two of the 8 symptoms measured. To take the complete survey, you can click on this link here. It only takes a few minutes.

Your score is then tabulated. It will be between 1-40. Zero means your COPD does not impair you at all. Forty means you are severely limited. Less than ten means you mostly have good COPD days. But, you may have some flare-ups. Greater than ten means your COPD impairs you to some degree.² Most people with COPD will score 25-40.¹

Both of these tests are nice. They help your doctor see how much your symptoms impair your ability to stay active. So, they both determine your “degree of functional impairment.” This is your “Symptoms” score.

Your doctor may use some other method of assessing your symptoms. But, the mMRC and CAT are what the COPD Guidelines recommend.

Learn from example

Basically, you take the number of flare-ups, or the number of flare-ups plus hospitalizations, and plug the number into the chart below. Then you take either your mMRC or CAT score and plug that into the chart below. You match up the results to find your letter (A, B, C, or D). Then this letter can be used to determine how best to treat you.

We have time for one example. So, say you have two people living with COPD. Let’s label them Jen and Jeff. They both are in Stage 4. Jen is able to live a normal, functioning life. She has had no flare-ups in the past year. Jeff is unable to go to the bathroom without feeling breathless.

So, on our chart, these two people, both living with stage 4 COPD, both have a different letter. Jen has a number 4 with a letter A. Jeff has a number 4 with a letter D. So, it only makes sense that they should both be treated differently.^1-2

I go over how this letter correlates with treatment in this post. So, remember your letter.