Wijnhoven H A, Kriegsman D M, Hesselink A E, Penninx B W, de Haan M
Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit, Amsterdam, The Netherlands.
Chest. 2001 Apr;119(4):1034-42. doi: 10.1378/chest.119.4.1034.
To identify determinants of pulmonary function and health-related quality of life (HRQOL) to better understand disease severity in patients with asthma and COPD.
Observational study.
Dutch general practice.
We studied 837 asthma patients and 231 COPD patients.
The association between pulmonary function and HRQOL was poor for asthma (beta = 0.10) and COPD (beta = 0.19). Multivariately, in asthma, lower pulmonary function was associated with male gender, region of living, current smoking, use of inhaled short-acting bronchodilators, longer duration of disease, and higher diurnal variation in peak expiratory flow. In COPD, lower pulmonary function was associated with male gender, use of inhaled bronchodilators, more days and nights disturbed by respiratory complaints, not wheezing, and bronchial hyperresponsiveness. Reduced HRQOL was associated most strongly with more days and nights disturbed by respiratory complaints and dyspnea in both asthma and COPD. In asthma, additional associations were found with younger age, lower educational level, region of living, comorbidity, use of inhaled bronchodilators and corticosteroids, wheezing, chronic cough, sputum production, and bronchial hyperresponsiveness. In COPD, lower age, not smoking, chronic cough, and sputum production were associated with reduced HRQOL.
Pulmonary function and HRQOL appear to highlight different aspects of disease severity in asthma and COPD. Therefore, both measures should be taken into account in order to get a complete picture of severity of disease.
确定肺功能和健康相关生活质量（HRQOL）的决定因素，以更好地了解哮喘和慢性阻塞性肺疾病（COPD）患者的疾病严重程度。
观察性研究。
荷兰全科医疗。
我们研究了837例哮喘患者和231例COPD患者。
哮喘（β = 0.10）和COPD（β = 0.19）患者中，肺功能与HRQOL之间的关联较弱。多因素分析显示，在哮喘患者中，较低的肺功能与男性、居住地区、当前吸烟、使用吸入性短效支气管扩张剂、疾病持续时间较长以及呼气峰值流速的昼夜变化较大有关。在COPD患者中，较低的肺功能与男性、使用吸入性支气管扩张剂、因呼吸道症状而干扰的白天和夜晚天数较多、无喘息以及支气管高反应性有关。在哮喘和COPD患者中，HRQOL降低与因呼吸道症状和呼吸困难而干扰的白天和夜晚天数较多最为密切相关。在哮喘患者中，还发现与年龄较小、教育水平较低、居住地区、合并症、使用吸入性支气管扩张剂和皮质类固醇、喘息、慢性咳嗽、咳痰以及支气管高反应性有关。在COPD患者中，年龄较小、不吸烟、慢性咳嗽和咳痰与HRQOL降低有关。
肺功能和HRQOL似乎突出了哮喘和COPD疾病严重程度的不同方面。因此，为全面了解疾病严重程度，应同时考虑这两种测量方法。
