Martinez Carlos H, Diaz Alejandro A, Parulekar Amit D, Rennard Stephen I, Kanner Richard E, Hansel Nadia N, Couper David, Holm Kristen E, Hoth Karin F, Curtis Jeffrey L, Martinez Fernando J, Hanania Nicola A, Regan Elizabeth A, Paine Robert, Cigolle Christine T, Han MeiLan K
Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI.
Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Chest. 2016 Apr;149(4):927-35. doi: 10.1016/j.chest.2015.11.025. Epub 2015 Dec 17.
Younger persons with COPD report worse health-related quality of life (HRQL) than do older individuals. The factors explaining these differences remain unclear. The objective of this article was to explore factors associated with age-related differences in HRQL in COPD.
Cross-sectional analysis of participants with COPD, any Global Initiative for Chronic Obstructive Lung Disease grade of airflow limitation, and ≥ 50 years old in two cohorts: the Genetic Epidemiology of COPD (COPDGene) study and the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS). We compared St. George's Respiratory Questionnaire (SGRQ) scores by age group: middle-aged (age, 50-64) vs older (age, 65-80) adults. We used multivariate linear modeling to test associations of age with HRQL, adjusting for demographic and clinical characteristics and comorbidities.
Among 4,097 participants in the COPDGene study (2,170 middle-aged and 1,927 older adults) SGRQ total scores were higher (worse) among middle-aged (mean difference, -4.2 points; 95% CI, -5.7 to -2.6; P < .001) than older adults. Age had a statistically significant interaction with dyspnea (P < .001). Greater dyspnea severity (modified Medical Research Council ≥ 2, compared with 0-1) had a stronger association with SGRQ score among middle-aged (β, 24.6; 95% CI, 23.2-25.9) than older-adult (β, 21.0; 95% CI, 19.6-22.3) participants. In analyses using SGRQ as outcome in 1,522 participants in SPIROMICS (598 middle-aged and 924 older adults), we found similar associations, confirming that for the same severity of dyspnea there is a stronger association with HRQL among younger individuals.
Age-related differences in HRQL may be explained by a higher impact of dyspnea among younger subjects with COPD.
ClinicalTrials.gov; No.: NCT00608764 and No.: NCT01969344; URL: www.clinicaltrials.gov.
慢性阻塞性肺疾病（COPD）患者中，较年轻者报告的健康相关生活质量（HRQL）比年长者更差。解释这些差异的因素仍不明确。本文的目的是探讨与COPD患者HRQL年龄相关差异有关的因素。
对两个队列中患有COPD、任何慢性阻塞性肺疾病全球倡议组织气流受限分级且年龄≥50岁的参与者进行横断面分析：COPD基因研究（COPDGene）和COPD亚组及中间结局指标研究（SPIROMICS）。我们按年龄组比较圣乔治呼吸问卷（SGRQ）得分：中年（年龄50 - 64岁）与老年（年龄65 - 80岁）成年人。我们使用多变量线性模型来测试年龄与HRQL的关联，并对人口统计学和临床特征以及合并症进行调整。
在COPDGene研究的4097名参与者中（2170名中年人和1927名老年人），中年人的SGRQ总分更高（更差）（平均差异为 - 4.2分；95%置信区间为 - 5.7至 - 2.6；P <.001）。年龄与呼吸困难存在统计学上的显著交互作用（P <.001）。与0 - 1级相比，更严重的呼吸困难程度（改良医学研究委员会分级≥2级）与中年参与者（β值为24.6；95%置信区间为23.2 - 25.9）的SGRQ得分的关联比老年参与者（β值为21.0；95%置信区间为19.6 - 22.3）更强。在以SGRQ作为结局指标对SPIROMICS研究的1522名参与者（598名中年人和924名老年人）进行的分析中，我们发现了类似的关联，证实对于相同严重程度的呼吸困难，年轻个体中与HRQL的关联更强。
COPD年轻患者中，呼吸困难的更高影响可能解释了HRQL的年龄相关差异。
ClinicalTrials.gov；编号：NCT00608764和编号：NCT01969344；网址：www.clinicaltrials.gov。
