Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.
Respirology. 2018 Dec;23(12):1146-1151. doi: 10.1111/resp.13324. Epub 2018 May 15.
Many patients with advanced COPD experience refractory breathlessness and individualized breathlessness interventions may improve management of this complex symptom. The aims of this study were to develop, implement and assess the efficacy of a breathlessness intervention for patients with COPD and refractory breathlessness and to evaluate patient acceptability.
An individualized breathlessness plan, information leaflets, breathlessness education and a hand-held fan were offered to consecutive patients with severe COPD and refractory breathlessness attending a tertiary integrated respiratory and palliative care service. Validated dyspnoea, quality of life and anxiety/depression questionnaires were administered at baseline and after 6 weeks, with change in dyspnoea scores being the primary outcome measure. A subset of patients participated in a structured telephone interview to qualitatively assess the intervention.
Twenty-six patients with severe COPD (mean forced expiratory volume in 1 s (FEV ) 38%) were included, with a mean age of 74 years. Mean modified Medical Research Council Breathlessness Scale score was 3.5. Anxiety and depression were common, being present in 38% and 35% of participants. At 6 weeks, there was a clinically significant improvement in breathlessness severity as measured by the Numerical Rating Scale. The subset of patients with anxiety/depression also saw significant improvement in all domains of the Self-Administered Standardized Chronic Respiratory Questionnaire (CRQ-SAS). Patients reported that the intervention was highly useful and acceptable.
This feasibility study of individualized breathlessness interventions in patients with severe COPD and refractory breathlessness is the first to demonstrate a clinically significant reduction in dyspnoea scores, with high levels of patient acceptability.
许多患有晚期 COPD 的患者会经历无法缓解的呼吸困难，针对这种复杂症状的个体化呼吸困难干预措施可能会改善其管理。本研究的目的是制定、实施并评估一种针对 COPD 合并难治性呼吸困难患者的呼吸困难干预措施的疗效，并评估患者的接受程度。
为连续就诊于三级综合呼吸与姑息治疗服务的严重 COPD 合并难治性呼吸困难患者提供个体化呼吸困难计划、信息手册、呼吸困难教育和手持风扇。在基线和 6 周时使用经过验证的呼吸困难、生活质量和焦虑/抑郁问卷进行评估，呼吸困难评分的变化是主要的观察指标。一部分患者接受了结构化电话访谈，以定性评估干预措施。
共纳入 26 例严重 COPD 患者（平均用力呼气量占预计值百分比（FEV ）为 38%），平均年龄为 74 岁。平均改良医学研究理事会呼吸困难量表评分为 3.5。焦虑和抑郁很常见，分别有 38%和 35%的患者存在。6 周后，数字评分量表评估的呼吸困难严重程度有明显的临床改善。在焦虑/抑郁的亚组患者中，慢性呼吸系统疾病自我管理量表（CRQ-SAS）的所有领域评分均有显著改善。患者报告称，该干预措施非常有用且易于接受。
本研究为严重 COPD 合并难治性呼吸困难患者的个体化呼吸困难干预措施的可行性研究，首次证明了呼吸困难评分的显著降低，且患者接受度高。
