Reardon Jane Z, Lareau Suzanne C, ZuWallack Richard
Hartford Hospital, Hartford, Connecticut, USA.
Am J Med. 2006 Oct;119(10 Suppl 1):32-7. doi: 10.1016/j.amjmed.2006.08.005.
Exertional dyspnea often causes patients with chronic obstructive pulmonary disease (COPD) to unconsciously reduce their activities of daily living (ADLs) to reduce the intensity of their distress. The reduction in ADLs leads to deconditioning which, in turn, further increases dyspnea. Both dyspnea and fatigue are important factors affecting health-related quality of life (HRQOL). The functional status of patients relates to how well they perform ADLs. Activities, however, may not be severely limited until the disease becomes advanced. The elimination of an ADL depends on the necessity or desirability of that activity and the intensity of the associated symptoms. HRQOL is measured using symptoms, functional status, and a rating of their impact on the individual. The Pulmonary Functional Status Scale (PFSS) and the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) are 2 COPD-specific functional status questionnaires. Pedometers or accelerometers can quantify the levels of activity of patients with COPD. HRQOL is measured with validated multidimensional questionnaires that cover symptoms, physical, psychological, and social domains. Ideally, these instruments are discriminative (i.e., separate degrees of impairment) and evaluative (i.e., detect small changes after therapy). HRQOL questionnaires may be generic (e.g., Medical Outcomes Study Short Form-36 [SF-36]) and can measure favorable changes after intervention, such as pulmonary rehabilitation, or they can be disease specific with disease-related domains, e.g., Chronic Respiratory Disease Questionnaire (CRQ) with domains of dyspnea, fatigue, emotion, and mastery; and St. George's Respiratory Questionnaire (SGRQ) with domains of symptoms, activity, and psychosocial impact. A case is presented that depicts how these tools may be used to evaluate improvement with intervention in a patient with COPD.
运动性呼吸困难常使慢性阻塞性肺疾病（COPD）患者无意识地减少日常生活活动（ADL），以减轻不适程度。ADL减少会导致身体机能下降，进而进一步加重呼吸困难。呼吸困难和疲劳都是影响健康相关生活质量（HRQOL）的重要因素。患者的功能状态与其ADL执行情况相关。然而，在疾病进展到晚期之前，活动可能不会受到严重限制。一项ADL的消除取决于该活动的必要性或可取性以及相关症状的严重程度。HRQOL通过症状、功能状态及其对个体影响的评分来衡量。肺功能状态量表（PFSS）和肺功能状态与呼吸困难问卷（PFSDQ）是两份针对COPD的功能状态问卷。计步器或加速度计可量化COPD患者的活动水平。HRQOL通过经过验证的多维问卷进行测量，这些问卷涵盖症状、身体、心理和社会领域。理想情况下，这些工具具有区分性（即区分不同程度的损伤）和评估性（即检测治疗后的微小变化）。HRQOL问卷可以是通用的（例如医学结局研究简表-36[SF-36]），能够测量干预后（如肺康复）的良好变化，也可以是针对特定疾病的，包含与疾病相关的领域，例如慢性呼吸系统疾病问卷（CRQ），其领域包括呼吸困难、疲劳、情绪和掌控感；以及圣乔治呼吸问卷（SGRQ），其领域包括症状、活动和心理社会影响。本文介绍了一个案例，描述了如何使用这些工具来评估COPD患者干预后的改善情况。
