Chai Chee-Shee, Liam Chong-Kin, Pang Yong-Kek, Ng Diana Leh-Ching, Tan Seng-Beng, Wong Tat-Seng, Sia Jo-Ee
Department of Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia.
Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia,
Int J Chron Obstruct Pulmon Dis. 2019 Mar 1;14:565-573. doi: 10.2147/COPD.S196109. eCollection 2019.
The Spanish COPD guideline (GesEPOC) classifies COPD into four clinical phenotypes based on the exacerbation frequency and dominant clinical manifestations. In this study, we compared the disease-specific health-related quality of life (HRQoL) of patients with different clinical phenotypes.
This was a cross-sectional study of patients with COPD attending the respiratory medicine clinic of University of Malaya Medical Centre from 1 June 2017 to 31 May 2018. Disease-specific HRQoL was assessed by using the COPD Assessment Test (CAT) and St George's Respiratory Questionnaire for COPD (SGRQ-c).
Of 189 patients, 28.6% were of non-exacerbator phenotype (NON-AE), 18.5% were of exacerbator with emphysema phenotype (AE NON-CB), 39.7% were of exacerbator with chronic bronchitis phenotype (AE CB), and 13.2% had asthma-COPD overlap syndrome phenotype (ACOS). The total CAT and SGRQ-c scores were significantly different between the clinical phenotypes (<0.001). Patients who were AE CB had significantly higher total CAT score than those with ACOS (=0.033), AE NON-CB (=0.001), and NON-AE (<0.001). Concerning SGRQ-c, patients who were AE CB also had a significantly higher total score than those with AE NON-CB (=0.001) and NON-AE (<0.001). However, the total SGRQ-c score of AE CB patients was only marginally higher than those who had ACOS (=0.187). There was a significant difference in the score of each CAT item (except CAT 7) and SGRQ-c components between clinical phenotypes, with AE CB patients recording the highest score in each of them.
Patients who were AE CB had significantly poorer HRQoL than other clinical phenotypes and recorded the worst score in each of the CAT items and SGRQ-c components. Therefore, AE CB patients may warrant a different treatment approach that focuses on the exacerbation and chronic bronchitis components.
西班牙慢性阻塞性肺疾病指南（GesEPOC）根据急性加重频率和主要临床表现将慢性阻塞性肺疾病分为四种临床表型。在本研究中，我们比较了不同临床表型患者的疾病特异性健康相关生活质量（HRQoL）。
这是一项对2017年6月1日至2018年5月31日在马来亚大学医学中心呼吸内科就诊的慢性阻塞性肺疾病患者进行的横断面研究。使用慢性阻塞性肺疾病评估测试（CAT）和慢性阻塞性肺疾病圣乔治呼吸问卷（SGRQ-c）评估疾病特异性健康相关生活质量。
189例患者中，28.6%为非急性加重表型（NON-AE），18.5%为合并肺气肿的急性加重表型（AE NON-CB），39.7%为合并慢性支气管炎的急性加重表型（AE CB），13.2%为哮喘-慢性阻塞性肺疾病重叠综合征表型（ACOS）。各临床表型之间的CAT总分和SGRQ-c总分存在显著差异（<0.001）。AE CB患者的CAT总分显著高于ACOS患者（=0.033）、AE NON-CB患者（=0.001）和NON-AE患者（<0.001）。关于SGRQ-c，AE CB患者的总分也显著高于AE NON-CB患者（=0.001）和NON-AE患者（<0.001）。然而，AE CB患者的SGRQ-c总分仅略高于ACOS患者（=0.187）。各临床表型之间CAT各项目（CAT 7除外）和SGRQ-c各组成部分的得分存在显著差异，AE CB患者在各项目和组成部分中的得分最高。
AE CB患者的健康相关生活质量明显低于其他临床表型，且在CAT各项目和SGRQ-c各组成部分中的得分最差。因此，AE CB患者可能需要一种不同的治疗方法，该方法应侧重于急性加重和慢性支气管炎成分。
