Nishimura Koichi, Nakamura Saya, Kusunose Masaaki, Nakayasu Kazuhito, Sanda Ryo, Hasegawa Yoshinori, Oga Toru
Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.
Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
BMJ Open Respir Res. 2018 Oct 9;5(1):e000305. doi: 10.1136/bmjresp-2018-000305. eCollection 2018.
The aim of this study was to investigate which patient-reported outcome measure was the best during the recovery phase from severe exacerbation of chronic obstructive pulmonary disease (COPD).
The Exacerbations of Chronic Pulmonary Disease Tool (EXACT), the COPD Assessment Test (CAT), the St George's Respiratory Questionnaire (SGRQ), the Dyspnoea-12 (D-12) and the Hyland Scale (global scale) were recorded every week for the first month and at 2 and 3 months in 33 hospitalised subjects with acute exacerbation of COPD (AECOPD).
On the day of admission (day 1), the internal consistency of the EXACT total score was high (Cronbach's alpha coefficient=0.89). The EXACT total, CAT, SGRQ total and Hyland Scale scores obtained on day 1 appeared to be normally distributed. Neither floor nor ceiling effects were observed for the EXACT total and SGRQ total scores. The EXACT total score improved from 50.5±12.4 to 32.5±14.3, and the CAT score also improved from 24.4±8.5 to 13.5±8.4 during the first 2 weeks, and the effect sizes (ES) of the EXACT total and CAT score were -1.40 and -1.36, respectively. The SGRQ, Hyland Scale and D-12 were less responsive, with ES of -0.59, 0.96 and -0.90, respectively.
The EXACT total and CAT scores are shown to be more responsive measures during the recovery phase from severe exacerbation. Considering the conceptual framework, it is recommended that the EXACT total score may be the best measure during the recovery phase from AECOPD. The reasons for the outstanding responsiveness of the CAT are still unknown.
本研究旨在调查在慢性阻塞性肺疾病（COPD）严重加重后的恢复阶段，哪种患者报告的结局指标最佳。
对33例因慢性阻塞性肺疾病急性加重（AECOPD）住院的患者，在第1个月每周记录慢性肺疾病加重工具（EXACT）、慢性阻塞性肺疾病评估测试（CAT）、圣乔治呼吸问卷（SGRQ）、呼吸困难12项问卷（D - 12）和海兰德量表（整体量表），并在第2个月和第3个月进行记录。
入院当天（第1天），EXACT总分的内部一致性较高（克朗巴哈α系数 = 0.89）。第1天获得的EXACT总分、CAT、SGRQ总分和海兰德量表分数似乎呈正态分布。EXACT总分和SGRQ总分均未观察到地板效应或天花板效应。在最初2周内，EXACT总分从50.5±12.4改善至32.5±14.3，CAT分数也从24.4±8.5改善至13.5±8.4，EXACT总分和CAT分数的效应量（ES）分别为 - 1.40和 - 1.36。SGRQ、海兰德量表和D - 12的反应性较低，ES分别为 - 0.59、0.96和 - 0.90。
EXACT总分和CAT分数在严重加重后的恢复阶段显示出更高的反应性。考虑到概念框架，建议EXACT总分可能是AECOPD恢复阶段的最佳指标。CAT反应性出色的原因尚不清楚。
