Lee Hyun, Jhun Byung Woo, Cho Juhee, Yoo Kwang Ha, Lee Jin Hwa, Kim Deog Kyeom, Lee Jong Deog, Jung Ki-Suck, Lee Jung Yeon, Park Hye Yun
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Int J Chron Obstruct Pulmon Dis. 2017 Nov 13;12:3301-3310. doi: 10.2147/COPD.S145910. eCollection 2017.
Patients with chronic obstructive pulmonary disease (COPD) often have poor health-related quality of life (HRQoL) that is disproportionate to their degree of airflow limitation. This study evaluated the association between St George's Respiratory Questionnaire for COPD (SGRQ-C) score and forced expiratory volume in one second and investigated the factors responsible for high SGRQ-C score according to severity of airflow limitation.
Data from 1,264 COPD patients were obtained from the Korean COPD Subgroup Study (KOCOSS) cohort. Patients were categorized into two groups according to severity of airflow limitation: mild-to-moderate and severe-to-very severe COPD groups. We evaluated the clinical factors associated with high SGRQ-C score (≥25) in each COPD patient group.
Of the 1,264 COPD patients, 902 (71.4%) had mild-to-moderate airflow limitation and 362 (28.6%) had severe-to-very severe airflow limitation. Of the mild-to-moderate COPD patients, 59.2% (534/902) had high SGRQ-C score, while 80.4% (291/362) of the severe-to-very severe COPD patients had high SGRQ-C score. The association between SGRQ-C score and post-bronchodilator forced expiratory volume in one second (% predicted) was very weak in the mild-to-moderate COPD patients (=-0.103, =0.002) and weak in the severe-to-very severe COPD patients (=-0.219, <0.001). Multiple logistic regression analysis revealed that age, being an ex- or current smoker, lower level of education, cough, dyspnea, and number of comorbidities with congestive heart failure, hyperlipidemia, and depression were significantly associated with high SGRQ-C score in mild-to-moderate COPD patients. In comparison, being an ex-smoker and having respiratory symptoms including sputum and dyspnea were significant factors associated with high SGRQ-C score in severe-to-very severe COPD patients.
In addition to the respiratory symptoms of dyspnea and cough, high SGRQ-C score was associated with extra-pulmonary comorbidities in mild-to-moderate COPD patients. However, only respiratory symptoms such as sputum and dyspnea were significantly associated with high SGRQ-C score in severe-to-very severe COPD patients. This indicates the need for an improved management strategy for relieving respiratory symptoms in COPD patients with poor HRQoL. In addition, attention should be paid to extra-pulmonary comorbidities, especially in mild-to-moderate COPD patients with poor HRQoL.
慢性阻塞性肺疾病（COPD）患者的健康相关生活质量（HRQoL）往往较差，与其气流受限程度不成比例。本研究评估了慢性阻塞性肺疾病圣乔治呼吸问卷（SGRQ-C）评分与一秒用力呼气量之间的关联，并根据气流受限的严重程度调查了导致SGRQ-C评分高的因素。
从韩国慢性阻塞性肺疾病亚组研究（KOCOSS）队列中获取了1264例COPD患者的数据。根据气流受限的严重程度将患者分为两组：轻度至中度和重度至极重度COPD组。我们评估了每组COPD患者中与高SGRQ-C评分（≥25）相关的临床因素。
在1264例COPD患者中，902例（71.4%）有轻度至中度气流受限，362例（28.6%）有重度至极重度气流受限。在轻度至中度COPD患者中，59.2%（534/902）的患者SGRQ-C评分高，而在重度至极重度COPD患者中，80.4%（291/362）的患者SGRQ-C评分高。在轻度至中度COPD患者中，SGRQ-C评分与支气管扩张剂后一秒用力呼气量（%预测值）之间的关联非常弱（=-0.103，=0.002），在重度至极重度COPD患者中关联较弱（=-0.219，<0.001）。多因素逻辑回归分析显示，年龄、曾经或现在吸烟、教育程度较低、咳嗽、呼吸困难以及合并充血性心力衰竭、高脂血症和抑郁症的合并症数量与轻度至中度COPD患者的高SGRQ-C评分显著相关。相比之下，曾经吸烟以及有包括咳痰和呼吸困难在内的呼吸道症状是重度至极重度COPD患者高SGRQ-C评分的重要相关因素。
除了呼吸困难和咳嗽等呼吸道症状外，轻度至中度COPD患者的高SGRQ-C评分还与肺外合并症有关。然而，在重度至极重度COPD患者中，只有咳痰和呼吸困难等呼吸道症状与高SGRQ-C评分显著相关。这表明需要改进管理策略以缓解HRQoL较差的COPD患者的呼吸道症状。此外，应关注肺外合并症，尤其是HRQoL较差的轻度至中度COPD患者。
