慢性阻塞性肺疾病全球倡议（GOLD）分类中改良的医学研究理事会呼吸困难量表能更好地反映日常生活中的身体活动情况。

Modified Medical Research Council Dyspnea Scale in GOLD Classification Better Reflects Physical Activities of Daily Living.

作者信息

Munari Anelise B, Gulart Aline A, Dos Santos Karoliny, Venâncio Raysa S, Karloh Manuela, Mayer Anamaria F

机构信息

Núcleo de Assistência, Ensino e Pesquisa em Reabilitação Pulmonar, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil and the Programa de Pós-Graduação em Fisioterapia, Centro de Ciências da Saúde e do Esporte (CEFID), Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.

出版信息

Respir Care. 2018 Jan;63(1):77-85. doi: 10.4187/respcare.05636. Epub 2017 Sep 5.

DOI:10.4187/respcare.05636

PMID:28874609

Abstract

BACKGROUND

In multidimensional Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, the choice of the symptom assessment instrument (modified Medical Research Council dyspnea scale [mMRC] or COPD assessment test [CAT]) can lead to a different distribution of patients in each quadrant. Considering that physical activities of daily living (PADL) is an important functional outcome in COPD, the objective of this study was to determine which symptom assessment instrument is more strongly associated with and differentiates better the PADL of patients with COPD.

METHODS

The study included 115 subjects with COPD (GOLD 2-4), who were submitted to spirometry, the mMRC, the CAT, and monitoring of PADL (triaxial accelerometer). Subjects were divided into 2 groups using the cutoffs proposed by the multidimensional GOLD classification: mMRC < 2 and ≥ 2 and CAT < 10 and ≥ 10.

RESULTS

Both mMRC and CAT reflected the PADL of COPD subjects. Subjects with mMRC < 2 and CAT < 10 spent less time in physical activities < 1.5 metabolic equivalents of task (METs) (mean of the difference [95% CI] = -62.9 [-94.4 to -31.4], < .001 vs -71.0 [-116 to -25.9], = .002) and had a higher number of steps (3,076 [1,999-4,153], < .001 vs 2,688 [1,042-4,333], = .002) than subjects with mMRC > 2 and CAT > 10, respectively. Physical activities ≥ 3 METs differed only between mMRC < 2 and mMRC ≥ 2 (39.2 [18.8-59.6], < .001). Furthermore, only the mMRC was able to predict the PADL alone (time active, r = 0.16; time sedentary, r = 0.12; time ≥ 3 METs, r = 0.12) and associated with lung function (number of steps, r = 0.35; walking time, r = 0.37; time < 1.5 METs, r = 0.25).

CONCLUSIONS

The mMRC should be adopted as the classification criterion for symptom assessment in the GOLD ABCD system when focusing on PADL.

摘要

背景

在慢性阻塞性肺疾病全球倡议（GOLD）多维分类中，症状评估工具（改良医学研究委员会呼吸困难量表[mMRC]或慢性阻塞性肺疾病评估测试[CAT]）的选择会导致各象限患者分布不同。鉴于日常生活身体活动（PADL）是慢性阻塞性肺疾病的一项重要功能指标，本研究的目的是确定哪种症状评估工具与慢性阻塞性肺疾病患者的PADL关联更强且区分度更好。

方法

本研究纳入了115例慢性阻塞性肺疾病（GOLD 2 - 4级）患者，对其进行肺功能测定、mMRC、CAT评估以及PADL监测（三轴加速度计）。根据多维GOLD分类提出的临界值将受试者分为两组：mMRC < 2和≥2组，以及CAT < 10和≥10组。

结果

mMRC和CAT均能反映慢性阻塞性肺疾病受试者的PADL。与mMRC > 2且CAT > 10的受试者相比，mMRC < 2且CAT < 10的受试者进行身体活动强度<1.5代谢当量任务（METs）的时间更短（平均差值[95%CI] = -62.9[-94.4至-31.4]，P <.001对比-71.0[-116至-25.9]，P =.002），步数更多（3,076[1,999 - 4,153]，P <.001对比2,688[1,042 - 4,333]，P =.002）。身体活动强度≥3 METs的情况仅在mMRC < 2和mMRC≥2之间存在差异（39.2[18.8 - 59.6]，P <.001）。此外，只有mMRC能够单独预测PADL（活动时间，r = 0.16；久坐时间，r = 0.12；≥3 METs时间，r = 0.12），并与肺功能相关（步数，r = 0.35；步行时间，r = 0.37；<1.5 METs时间，r = 0.25）。