Gruenberger Jean-Bernard, Vietri Jeffrey, Keininger Dorothy L, Mahler Donald A
Health Economics and Outcomes Research, Novartis Pharma AG, Basel, Basel-Stadt, Switzerland.
Health Outcomes Practice, Kantar Health, Horsham, PA.
Int J Chron Obstruct Pulmon Dis. 2017 Mar 20;12:937-944. doi: 10.2147/COPD.S123744. eCollection 2017.
Dyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD). However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports.
Data were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000). Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2), work impairment (Work Productivity and Activity Impairment questionnaire), and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions.
Of the 768 respondents who met the inclusion criteria, 245 (32%) were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2). Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%, <0.001) and number of emergency room visits (0.61 vs 0.40, =0.030) were higher in patients with greater dyspnea.
Many European patients with COPD continue to experience dyspnea despite treatment and at levels associated with notable impairments in the patients' ability to function across a multitude of domains. These patients may benefit from more intense treatment of their symptoms.
呼吸困难是慢性阻塞性肺疾病（COPD）分类和治疗中的一个关键症状。然而，有症状的COPD患者的负担变化程度以及负担的可能相关因素仍不明确。本研究旨在根据患者报告评估的社会人口统计学、健康相关生活质量、工作生产力受损情况和医疗资源使用情况，对欧洲目前正在接受COPD治疗的患者按呼吸困难程度进行特征描述。
数据来自2013年欧盟5国国民健康与幸福调查（N = 62,000）。年龄≥40岁且报告目前正在使用COPD处方的受访者，根据慢性阻塞性肺疾病全球倡议指南中的呼吸困难程度进行分组，并使用具有适当分布和链接函数的广义线性模型，对健康状况（修订的简短健康调查问卷36项[SF - 36]v2）、工作受损情况（工作生产力和活动受损问卷）以及过去6个月的医疗就诊次数进行比较。
在符合纳入标准的768名受访者中，245名（32%）被认为有较高的呼吸困难（相当于改良医学研究委员会评分≥2）。在对社会人口统计学、一般健康特征和COPD诊断时长进行调整后，较高的呼吸困难与SF - 36健康状况量表所有八个领域中3.9至8.2分的降幅相关；心理成分汇总得分和简短健康调查问卷6维度健康效用得分分别降低3.5分和0.06分。呼吸困难较重的患者经调整后的平均活动受损率（55%对37%，<0.001）和急诊就诊次数（0.61对0.40，=0.030）更高。
许多欧洲COPD患者尽管接受了治疗，但仍存在呼吸困难，且其程度与患者在多个领域的功能显著受损相关。这些患者可能从更强化的症状治疗中获益。
