Martínez-Moragón Eva, Perpiñá Miguel, Belloch Amparo, de Diego Alfredo, Martínez-Francés Manuela
Service of Pneumology, Sagunt Hospital, Port Sagunt, Valencia, Spain.
J Asthma. 2003 Jun;40(4):375-82. doi: 10.1081/jas-120018637.
Dyspnea is a main feature of symptomatology in asthma, and its perception does not necessarily correlates well with airway obstruction. The aim of this study was twofold: (1) to identify factors determining the subjective degree of dyspnea in patients with different grades of stable bronchial asthma and (2) to compare various clinical methods existing for grading dyspnea. The investigation comprised 153 outpatients with stable asthma. The parameters studied were the following: demographic characteristic of subjects, baseline dyspnea score by means of three clinical instruments (baseline dyspnea index [BDI], Medical Research Council [MRC] scale, and modified Borg scale), asthma severity, standard measures of physiologic lung function, anxiety, depression, subconscious illness attention, and asthma-related quality of life (HRQOL). The dyspnea scores were all significantly interrelated (r=0.77-0.85, p<0.001). The three clinical scales for grading dyspnea were significantly correlated with the same parameters: airflow obstruction, lung hyperinflation, emotional factors, HRQOL, age, age at asthma onset, asthma duration, female gender, clinical severity, and lower economical, and educational levels. Multiple regression analysis showed that independent factors determining clinical dyspnea scores were: age, airway obstruction, and emotional status. Moreover, in patients with severe asthma, lung hyperinflation helped to explain the individual dyspnea score. These data suggest that clinical methods are appropriate for evaluating the impact of dyspnea on daily activities of asthmatic patients. BDI, MRC, and Borg clinical dyspnea scales showed similarly information in subjects with asthma. Independently of asthma severity, older age, airway obstruction, and psychological disturbance were associated with higher degree of dyspnea. However, if subjects had severe airway obstruction, lung hyperinflation was a major determinant of baseline dyspnea score.
呼吸困难是哮喘症状学的主要特征，其感知与气道阻塞不一定密切相关。本研究的目的有两个：（1）确定不同程度稳定期支气管哮喘患者主观呼吸困难程度的决定因素；（2）比较现有的各种呼吸困难分级临床方法。该调查纳入了153例稳定期哮喘门诊患者。研究的参数如下：受试者的人口统计学特征、通过三种临床工具测得的基线呼吸困难评分（基线呼吸困难指数[BDI]、医学研究委员会[MRC]量表和改良的Borg量表）、哮喘严重程度、肺功能的标准生理指标、焦虑、抑郁、潜意识疾病关注度以及哮喘相关生活质量（HRQOL）。呼吸困难评分之间均显著相关（r = 0.77 - 0.85，p < 0.001）。三种呼吸困难分级临床量表与相同参数显著相关：气流阻塞、肺过度充气、情绪因素、HRQOL、年龄、哮喘发病年龄、哮喘病程、女性性别、临床严重程度以及较低的经济和教育水平。多元回归分析表明，决定临床呼吸困难评分的独立因素为：年龄、气道阻塞和情绪状态。此外，在重度哮喘患者中，肺过度充气有助于解释个体呼吸困难评分。这些数据表明，临床方法适用于评估呼吸困难对哮喘患者日常活动的影响。BDI、MRC和Borg临床呼吸困难量表在哮喘患者中显示出相似的信息。无论哮喘严重程度如何，年龄较大、气道阻塞和心理障碍与较高程度的呼吸困难相关。然而，如果受试者存在严重气道阻塞，肺过度充气是基线呼吸困难评分的主要决定因素。
