Chuang Ming-Lung, Lin I-Feng, Lee Chai-Yuan
Division of Pulmonary Medicine and Departments of Internal Medicine and Critical Care Medicine School of Medicine, Chung Shan Medical University, Taichung Institute and Department of Public Health, National Yang Ming University, Taipei Department of Nursing, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC.
Medicine (Baltimore). 2016 Nov;95(47):e5471. doi: 10.1097/MD.0000000000005471.
Exertional dyspnea scales (EDS) and health-related quality-of-life questionnaires (HRQoLQs) are used to assess chronic obstructive pulmonary disease (COPD). The GOLD guidelines categorize patients according to either 1 of these 2 domains, the lung function and the frequency of acute exacerbations in the preceding year, however with inconsistent results. Combining EDS and HRQoLQs may yield better results; however, the best combination is unclear. Whether the EDS quantifies the exercise capacity or the dyspnea perception is also unclear. The study was designed to correlate the EDS with exercise capacity and dyspnea perception and to evaluate the best combination of the EDS and HRQoLQ.Three EDS were compared by exercise capacity and Borg scores at rest and during exercise in 57 patients with COPD. Three HRQoLQs were compared by 4 domains of clinical assessments, and 2 types of exercise. The strength of correlation |r| was categorized by quartiles from <0.3 to ≥0.6.The EDS was better correlated with exercise capacities (|r| = 0.29-0.65, P < 0.05-<0.0001) than with the resting and exertional Borg scores (|r| = 0.08-0.55, P = NS- <0.0001). The EDS were moderately to strongly interrelated, but this correlation was weaker when including Oxygen-cost Diagram (OCD) (with the modified Medical Research Council, mMRC r = -0.56, with the baseline dyspnea index, BDI r = 0.49 vs. mMRC with BDI r = -0.73); however, the OCD had the strongest correlation with walking distance (r = 0.65, vs mMRC r = -0.59, BDI r = 0.5) and peak oxygen uptake (r = 0.39 vs mMRC r = -0.29, BDI r = 0.36). Among the HRQoLQs, the COPD assessment test (CAT) was most strongly correlated with the St. George Respiratory Questionnaire (SGRQ) (r = 0.77) and similar to the SGRQ regarding significant correlations with the other instruments (|r| = 0.29-0.67 vs. 0.36-0.77) but poorly with walking distance (r = -0.02). The OCD was mildly correlated with the CAT (r = -0.4).The EDS was more related to the exercise capacity than to the dyspnea perception and the CAT was most closely related to the other instruments but poorly with walking distance. The OCD can be used to compensate for this weak correlation. The study suggests using the CAT and the OCD simultaneously when undertaking clinical evaluation of patients with COPD.
运动性呼吸困难量表（EDS）和健康相关生活质量问卷（HRQoLQ）用于评估慢性阻塞性肺疾病（COPD）。慢性阻塞性肺疾病全球倡议（GOLD）指南根据这两个领域之一，即肺功能和前一年急性加重的频率对患者进行分类，然而结果并不一致。将EDS和HRQoLQ结合起来可能会产生更好的结果；然而，最佳组合尚不清楚。EDS是量化运动能力还是呼吸困难感知也不清楚。本研究旨在将EDS与运动能力和呼吸困难感知相关联，并评估EDS和HRQoLQ的最佳组合。在57例COPD患者中，通过运动能力以及静息和运动时的Borg评分比较了三种EDS。通过临床评估的4个领域和2种运动类型比较了三种HRQoLQ。相关性强度|r|按四分位数分类，范围从<0.3到≥0.6。与静息和运动时的Borg评分（|r| = 0.08 - 0.55，P = 无显著性差异 - <0.0001）相比，EDS与运动能力的相关性更好（|r| = 0.29 - 0.65，P < 0.05 - <0.0001）。这些EDS之间存在中度至强相关性，但纳入氧耗图（OCD）时这种相关性较弱（改良医学研究委员会量表，mMRC，r = -0.56；基线呼吸困难指数，BDI，r = 0.49，而mMRC与BDI，r = -0.73）；然而，OCD与步行距离（r =
