University of Genoa, Allergy and Respiratory Disease Clinic, Department of Internal Medicine, Genoa, Italy.
Curr Med Res Opin. 2011 May;27(5):981-6. doi: 10.1185/03007995.2011.563285. Epub 2011 Mar 8.
To assess the presence of disability in chronic obstructive pulmonary disease (COPD) patients and its relationships with disease severity, comorbidities, and patient-reported outcomes.
COPD outpatients completed validated questionnaires designed to investigate illness perception, well-being, quality of life, and stress, while physicians collected data concerning disability, dyspnea, and comorbidities (Charlson Index).
Of 164 patients, 37.3% exhibited a degree of disability and 67.7 % of them reported the loss of at least one relevant function in daily life (mean 2.34 ± 2.41). Although disability was associated with disease severity (χ(2) = 8.292; p < 0.016), disability was present to some degree in all disease stages and in 44.9% of patients with moderate COPD. Barthel Index scores were related to MRC scores (r = 0.529; p < 0.001), GOLD stage (r = 0.223; p < 0.006), and Charlson Index (r = 0.163; p < 0.032). Disabled patients had a lower mean FEV(1) value (50.96 ± 20.99 vs. 65.00 ± 23.63; p < 0.001) than self-sufficient patients (p < 0.001). The stepwise regression analysis showed that the MRC score was the most relevant factor in inducing COPD patient disability (F = 56.5; p = 0.001). Compared to self-sufficient patients, disabled patients reported lower levels of well-being and health status, increased levels of distress, and a different illness perception.
Disability can be identified in each disease stage, with dyspnea serving as the most relevant inducing factor. Since disability substantially impacts patient perception of and experience with COPD, its presence must be taken into account during disease management. The cross-sectional nature of the study and the characteristics of the sample size represent a limitation in the possibility to generalize the results.
评估慢性阻塞性肺疾病（COPD）患者的残疾程度及其与疾病严重程度、合并症和患者报告结局的关系。
COPD 门诊患者完成了旨在调查疾病认知、幸福感、生活质量和压力的验证问卷，而医生收集了与残疾、呼吸困难和合并症（Charlson 指数）相关的数据。
在 164 名患者中，37.3%存在一定程度的残疾，其中 67.7%报告在日常生活中丧失了至少一项相关功能（平均 2.34 ± 2.41）。尽管残疾与疾病严重程度相关（χ(2) = 8.292；p < 0.016），但在所有疾病阶段和 44.9%的中度 COPD 患者中都存在一定程度的残疾。巴氏指数评分与 MRC 评分相关（r = 0.529；p < 0.001）、GOLD 分期（r = 0.223；p < 0.006）和 Charlson 指数（r = 0.163；p < 0.032）。残疾患者的平均 FEV(1)值（50.96 ± 20.99）低于自足患者（p < 0.001）。逐步回归分析显示，MRC 评分是导致 COPD 患者残疾的最相关因素（F = 56.5；p = 0.001）。与自足患者相比，残疾患者报告的幸福感和健康状况较低，苦恼程度增加，对疾病的认知不同。
残疾可以在每个疾病阶段中识别出来，呼吸困难是最相关的诱发因素。由于残疾对患者对 COPD 的认知和体验有很大影响，因此在疾病管理过程中必须考虑到残疾的存在。研究的横断面性质和样本量的特点限制了结果的推广。
