Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Respir Med. 2013 Dec;107(12):1977-85. doi: 10.1016/j.rmed.2013.06.019. Epub 2013 Jul 24.
Chronic Obstructive Pulmonary Disease (COPD) impairs quality of life and presents symptoms that affect the lives of patients. Our study analysed the degree of concordance between the patients and their pulmonologists in the perception of the severity of symptoms. A cross-sectional, descriptive, multicentre study was conducted in patients with COPD. From a list of 10 symptoms (cough, dry mouth, chest pain, expectoration, wheezing/whistling in the lungs, depression/sadness/discouragement, fatigue/tiredness/general lack of energy, anxiety/nervousness, breathlessness/shortness of breath upon exertion and difficulty sleeping/sleep disorders) each investigator and patient assessed those which, in their opinion, most concerned or affected the patient. A total of 450 patients were included in the study (91.3% males, 66.7 years old (SD = 10.2), FEV1(%) 51.7% (SD = 12.7%)). At an aggregate level, breathlessness/shortness of breath, fatigue/tiredness and coughing were identified by patients and physicians as being the most relevant symptoms. However, according to the concordance analysis conducted with individual pairs (each pulmonologist with his/her patient), only 52.8% coincided when identifying the symptom that most concerned or affected the life of the patient. The concordance analysed by the Kappa index between patients and physicians was poor (<0.42). The degree of physician-patient concordance was greater in patients with more severe COPD. The patients and their pulmonologists identified the same three main symptoms of COPD but showed low concordance when assessing the impact of the symptoms of the illness.
慢性阻塞性肺疾病（COPD）会降低生活质量，并出现影响患者生活的症状。我们的研究分析了患者及其肺病专家在症状严重程度感知方面的一致性程度。这是一项在 COPD 患者中进行的横断面、描述性、多中心研究。从一组 10 种症状（咳嗽、口干、胸痛、咳痰、肺部哮鸣/喘鸣、抑郁/悲伤/沮丧、疲劳/疲倦/全身乏力、焦虑/紧张、用力时呼吸困难/呼吸急促和睡眠困难/睡眠障碍）中，每位研究者和患者都评估了他们认为最关心或影响患者的症状。共有 450 名患者纳入研究（91.3%为男性，66.7 岁（SD=10.2），FEV1（%）51.7%（SD=12.7%））。在综合水平上，呼吸困难/呼吸急促、疲劳/疲倦和咳嗽被患者和医生认为是最相关的症状。然而，根据对个体对（每位肺病专家及其患者）进行的一致性分析，只有 52.8%的患者在确定最关心或影响患者生活的症状时与医生意见一致。通过 Kappa 指数分析患者和医生之间的一致性程度较差（<0.42）。COPD 病情更严重的患者中，医生与患者之间的一致性程度更高。患者及其肺病专家确定了 COPD 的三个主要症状相同，但在评估疾病症状的影响时一致性程度较低。
