Jones Paul W, Brusselle Guy, Dal Negro Roberto W, Ferrer Montse, Kardos Peter, Levy Mark L, Perez Thierry, Soler Cataluña Juan José, van der Molen Thys, Adamek Lukasz, Banik Norbert
Division of Clinical Science, St George's, University of London, London, UK.
Prim Care Respir J. 2012 Sep;21(3):329-36. doi: 10.4104/pcrj.2012.00065.
Most patients with chronic obstructive pulmonary disease (COPD) in Europe are treated in primary care, but perceptions on what guides primary care physicians (PCPs) in managing patients are lacking.
To describe factors associated with the assessment by PCPs of COPD severity and those associated with impaired health status, as assessed by patient-reported outcomes.
This cross-sectional study evaluated health-related quality of life (HRQL) in 2,294 COPD patients from five European countries. The severity of COPD was clinically judged by the PCPs and GOLD stage severity was calculated using spirometry data.
PCPs' categories of severity reflected a wider range of HRQL scores (St George's Respiratory Questionnaire (SGRQ) total score: mild 30.3; moderate 41.7; severe 55.0; very severe 66.1) than GOLD severity grading (Stage I 38.2; Stage II 41.1; Stage III 49.9; Stage IV 58.5). Multiple ordinal logistic regression models showed that factors most closely related to PCP-rated COPD severity were Medical Research Council (MRC) dyspnoea grade, forced expiratory volume in 1 second (FEV₁) percent predicted, HRQL score (either SGRQ or COPD Assessment Test (CAT)), and previous hospitalisations (model generalised R²=0.45 or 0.44 (SQRQ or CAT in model, respectively); all factors p<0.0001). Factors with the highest association with HRQL scores (SGRQ or CAT) were MRC dyspnoea grade, COPD severity (PCP-rated), sputum production, and number of co-morbidities (model R²=0.46 or 0.37 (SQRQ or CAT in multiple linear regression model, respectively); all factors p<0.0001).
PCPs successfully graded COPD severity clinically and appeared to have greater discriminative power for assessing severity in COPD than FEV₁-based staging. Their more holistic approach appeared to reflect the patients' HRQL rating and was consistent across five European countries.
欧洲大多数慢性阻塞性肺疾病（COPD）患者在初级保健机构接受治疗，但对于指导初级保健医生（PCP）管理患者的因素缺乏相关认识。
描述与初级保健医生评估COPD严重程度相关的因素，以及与患者报告结局所评估的健康状况受损相关的因素。
这项横断面研究评估了来自五个欧洲国家的2294例COPD患者的健康相关生活质量（HRQL）。PCP对COPD的严重程度进行临床判断，并使用肺活量测定数据计算GOLD阶段严重程度。
与GOLD严重程度分级（I期38.2；II期41.1；III期49.9；IV期58.5）相比，PCP的严重程度分类反映出更广泛的HRQL评分范围（圣乔治呼吸问卷（SGRQ）总分：轻度30.3；中度41.7；重度55.0；极重度66.1）。多个有序逻辑回归模型显示，与PCP评定的COPD严重程度最密切相关的因素是医学研究委员会（MRC）呼吸困难分级、预测的1秒用力呼气容积（FEV₁）百分比、HRQL评分（SGRQ或慢性阻塞性肺疾病评估测试（CAT））以及既往住院史（模型广义R²分别为0.45或0.44（模型中分别为SQRQ或CAT）；所有因素p<0.0001）。与HRQL评分（SGRQ或CAT）关联度最高的因素是MRC呼吸困难分级、COPD严重程度（PCP评定）、痰液产生以及合并症数量（模型R²分别为0.46或0.37（多元线性回归模型中分别为SQRQ或CAT）；所有因素p<0.0001）。
PCP在临床上成功地对COPD严重程度进行了分级，并且在评估COPD严重程度方面似乎比基于FEV₁的分期具有更大的鉴别力。他们更全面的方法似乎反映了患者的HRQL评分，并且在五个欧洲国家是一致的。
