基于调查的慢性阻塞性肺疾病严重程度评分的开发与验证

Development and validation of a survey-based COPD severity score.

作者信息

Eisner Mark D, Trupin Laura, Katz Patricia P, Yelin Edward H, Earnest Gillian, Balmes John, Blanc Paul D

机构信息

Department of Medicine, University of California, San Francisco, 350 Parnassus Ave, Ste 609, San Francisco, CA 94117, USA.

出版信息

Chest. 2005 Jun;127(6):1890-7. doi: 10.1378/chest.127.6.1890.

DOI:10.1378/chest.127.6.1890

PMID:15947299

Abstract

OBJECTIVE

To develop a comprehensive disease-specific COPD severity instrument for survey-based epidemiologic research.

STUDY DESIGN AND SETTING

Using a population-based sample of 383 US adults with self-reported physician-diagnosed COPD, we developed a disease-specific COPD severity instrument. The severity score was based on structured telephone interview responses and included five overall aspects of COPD severity: respiratory symptoms, systemic corticosteroid use, other COPD medication use, previous hospitalization or intubation, and home oxygen use. We evaluated concurrent validity by examining the association between the COPD severity score and three health status domains: pulmonary function, physical health-related quality of life (HRQL), and physical disability. Pulmonary function was available for a subgroup of the sample (FEV1, n = 49; peak expiratory flow rate [PEFR], n = 93).

RESULTS

The COPD severity score had high internal consistency reliability (Cronbach alpha = 0.80). Among the 49 subjects with FEV1 data, higher COPD severity scores were associated with poorer percentage of predicted FEV1 (r = - 0.40, p = 0.005). In the 93 subjects with available PEFR measurements, greater COPD severity was also related to worse percentage of predicted PEFR (r = - 0.35, p < 0.001). Higher COPD severity scores were strongly associated with poorer physical HRQL (r = - 0.58, p < 0.0001) and greater restricted activity attributed to a respiratory condition (r = 0.59, p < 0.0001). Higher COPD severity scores were also associated with a greater risk of difficulty with activities of daily living (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.8 to 3.0) and inability to work (OR, 4.2; 95% CI, 3.0 to 5.8).

CONCLUSION

The COPD severity score is a reliable and valid measure of disease severity, making it a useful research tool. The severity score, which does not require pulmonary function measurement, can be used as a study outcome or to adjust for disease severity.

摘要

目的

开发一种用于基于调查的流行病学研究的综合性、针对特定疾病的慢性阻塞性肺疾病（COPD）严重程度评估工具。

研究设计与背景

我们以383名自我报告有医生诊断为COPD的美国成年人为基于人群的样本，开发了一种针对特定疾病的COPD严重程度评估工具。严重程度评分基于结构化电话访谈的回答，涵盖COPD严重程度的五个总体方面：呼吸道症状、全身使用皮质类固醇、使用其他COPD药物、既往住院或插管以及家庭吸氧使用情况。我们通过检查COPD严重程度评分与三个健康状况领域之间的关联来评估同时效度：肺功能、与身体健康相关的生活质量（HRQL）和身体残疾。样本中的一个亚组可获得肺功能数据（第1秒用力呼气容积[FEV1]，n = 49；呼气峰值流速[PEFR]，n = 93）。

结果

COPD严重程度评分具有较高的内部一致性信度（克朗巴哈系数α = 0.80）。在49名有FEV1数据的受试者中，较高的COPD严重程度评分与预测FEV1百分比越低相关（r = - 0.40，p = 0.005）。在93名有可用PEFR测量值的受试者中，更高的COPD严重程度也与预测PEFR百分比越差相关（r = - 0.35，p < 0.001）。较高的COPD严重程度评分与较差的身体HRQL（r = - 0.58，p < 0.00·=01）以及因呼吸状况导致的活动受限程度更高（r = 0.59，p < 0.0001）密切相关。较高的COPD严重程度评分还与日常生活活动困难风险增加（优势比[OR]，2.3；9·=5%置信区间[CI]，1.8至3.0）和无法工作（OR，4.2；95%CI，3.0至5.8）相关。