Section of Pulmonary & Critical Care Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH 03756-0001, USA.
COPD. 2012 Aug;9(5):522-7. doi: 10.3109/15412555.2012.701678. Epub 2012 Aug 9.
Although guidelines recommend monitoring symptoms in patients with chronic obstructive pulmonary disease (COPD), there is limited information on the longitudinal changes in patient-reported dyspnea (PRD) related to activities of daily living. The hypothesis was that PRD scores on the modified Medical Research Council (mMRC) scale, the self-administered computerized (SAC) transition dyspnea index (TDI), and the University of California San Diego Shortness of Breath questionnaire (UCSD SOBQ) would demonstrate progression over two years.
Observational cohort study of symptomatic patients with stable COPD evaluated every 6 months for 2 years. Patients rated the impact of activities of daily living on dyspnea using three patient-reported instruments presented in random order, and then performed post-bronchodilator (pBD) spirometry.
Seventy patients (37 female/33 male; age: 66 ± 9 years; and pBD forced expiratory volume in one second [(FEV1): 51 ± 16% predicted] participated. Using fixed effects regression modeling, there was significant worsening in the PRD scores with the SAC TDI (-0.9 ± 2.7; p = 0.03) and UCSD SOBQ (+5.7 ± 18.3; p = 0.001), but not with the mMRC scale (p = 0.52). Both pBD FEV1 (p = 0.19) and pBD forced vital capacity (p = 0.65) were unchanged.
Multidimensional instruments (SAC TDI and UCSD SOBQ) demonstrated the frequently observed decline in PRD experienced by patients with COPD. The progression in PRD occurred despite stable lung function. Monitoring PRD provides unique clinical information and should be considered along with measuring lung function to assess patient status over time.
尽管指南建议监测慢性阻塞性肺疾病（COPD）患者的症状，但有关与日常活动相关的患者报告呼吸困难（PRD）的纵向变化的信息有限。假设改良的医学研究委员会（mMRC）量表、自我管理的计算机化（SAC）呼吸困难指数（TDI）和加利福尼亚大学圣地亚哥短气问卷（UCSD SOBQ）的 PRD 评分会在两年内逐渐增加。
对稳定的 COPD 有症状的患者进行了观察性队列研究，每 6 个月评估一次，为期 2 年。患者使用三种患者报告的仪器中的随机顺序评估日常生活活动对呼吸困难的影响，然后进行支气管扩张剂后（pBD）肺功能检查。
70 名患者（37 名女性/33 名男性；年龄：66 ± 9 岁；pBD 第一秒用力呼气量（FEV1）：51 ± 16%预计值）参与了研究。使用固定效应回归模型，SAC TDI 的 PRD 评分明显恶化（-0.9 ± 2.7；p = 0.03），UCSD SOBQ 也恶化（+5.7 ± 18.3；p = 0.001），但 mMRC 量表无变化（p = 0.52）。pBD FEV1（p = 0.19）和 pBD 用力肺活量（p = 0.65）均无变化。
多维仪器（SAC TDI 和 UCSD SOBQ）证明了 COPD 患者经常经历的 PRD 下降。尽管肺功能稳定，但 PRD 仍在进展。监测 PRD 提供了独特的临床信息，应与测量肺功能一起考虑，以随时间评估患者的状况。
