Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Germany.
Department of Medical Informatics, University Hospital Aachen, Aachen, Germany.
Lung. 2019 Feb;197(1):21-28. doi: 10.1007/s00408-018-0170-2. Epub 2018 Oct 10.
Dyspnea is one of the most disturbing symptoms for patients with chronic obstructive pulmonary disease (COPD) or heart failure (HF). This study investigated dyspnea triggers and factors associated with worsening dyspnea in patients with COPD or HF.
COPD support group members and HF patients with reduced ejection fraction (HFrEF) and no airway obstruction answered a questionnaire describing different weather conditions (rising/falling air pressure, sunny, foggy, rainy, windy, snowy, hazy, high ozone levels, and airborne pollen) and environmental circumstances (cooking, grilling, perfumes, cigarette smoke, gasoline odor, and flower scents) and were asked to estimate the occurrence and severity of dyspnea under these conditions using predefined scales.
230 patients with COPD and 90 with HFrEF (left ventricular ejection fraction 34 ± 10%, Tiffeneau index > 70%) were analyzed. COPD patients reported dyspnea more often than HF patients in almost all weather and environmental conditions (p = 0.004 to p < 0.001), with the exception of outdoor floral scents and cigarette smoke. Severe to very severe dyspnea was reported more in COPD versus HF in all weather and environmental conditions except sunny weather (p = 0.01 to p < 0.001). COPD was associated with more severe dyspnea than HF in all conditions (all p < 0.001).
Dyspnea was triggered by a variety of weather and other environmental triggers in patients with COPD and occurred more often than in HF patients under the same conditions. Foggy weather and exposure to perfumes were associated with severe dyspnea in the majority of COPD patients, but only a minority of HF patients.
呼吸困难是慢性阻塞性肺疾病（COPD）或心力衰竭（HF）患者最困扰的症状之一。本研究调查了 COPD 或 HF 患者呼吸困难的诱因以及与呼吸困难恶化相关的因素。
COPD 支持小组成员和射血分数降低的心力衰竭（HFrEF）且无气道阻塞的患者回答了一份问卷，描述了不同的天气条件（气压升高/降低、晴天、雾天、雨天、大风天、雪天、阴霾天、高臭氧水平和空气中花粉）和环境情况（烹饪、烧烤、香水、香烟烟雾、汽油味和花香），并要求他们使用预设的量表估计在这些条件下呼吸困难的发生和严重程度。
分析了 230 名 COPD 患者和 90 名 HFrEF 患者（左心室射血分数 34±10%，Tiffeneau 指数>70%）。与 HF 患者相比，COPD 患者在几乎所有天气和环境条件下报告呼吸困难的频率更高（p=0.004 至 p<0.001），但在户外花香和香烟烟雾除外。在所有天气和环境条件下，除晴天外，严重至非常严重的呼吸困难在 COPD 中比 HF 更常见（p=0.01 至 p<0.001）。在所有条件下，COPD 与比 HF 更严重的呼吸困难相关（所有 p<0.001）。
在 COPD 患者中，各种天气和其他环境诱因可引发呼吸困难，在相同条件下，呼吸困难比 HF 患者更常见。雾天和接触香水与大多数 COPD 患者的严重呼吸困难相关，但只有少数 HF 患者。
