多学科门诊护理对 COPD 患者结局的临床影响。
Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD.
机构信息
Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA.
Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
出版信息
Int J Chron Obstruct Pulmon Dis. 2020 Jan 8;15:33-42. doi: 10.2147/COPD.S225156. eCollection 2020.
PURPOSE
Heterogeneous nature of Chronic Obstructive Pulmonary Disease (COPD) must be comprehensively addressed. It is unclear if integrative multidisciplinary disease management (IMDM) can optimize clinical outcomes of patients with COPD.
METHODS
A single-center, retrospective cohort observational study with a historical intervention was conducted in a clinic specialized for COPD care. Patients with a confirmed diagnosis of COPD were administered IMDM with measurement of BODE score on initial and follow-up visits. Primary outcomes were dynamic changes in BODE quartiles after receiving IMDM.
RESULTS
Of 124 patients, 21% were misdiagnosed with COPD. Patients with a confirmed diagnosis of COPD were 50% female, median age 64 years (IQR 57-70), 43% actively smoking and initial visit median BODE quartile 2 (IQR 1-3). Three subgroups were identified based on the changes in BODE quartiles: worsened (21%), unchanged (55%) and improved (24%). At baseline, mMRC (median [IQR]) was higher in improved subgroup vs worsened and unchanged subgroup (3 [3, 4] vs 2 [1, 2] vs 2 [1, 3], p value 0.002) respectively. Drop in all components of BODE score was noted in worsened group, but significant improvement in mMRC with preservation of spirometry values was noted in the improved group. The incidence of smoking cigarettes changed from 39% to 26% during follow-up.
CONCLUSION
Our study demonstrates that IMDM can be potentially effective in a subgroup of COPD patients. In others precipitous drop in lung function, activity tolerance, and subjective symptoms seems inevitable with worsening BODE quartiles.
目的
慢性阻塞性肺疾病（COPD）具有异质性，必须全面加以解决。目前尚不清楚综合多学科疾病管理（IMDM）是否能优化 COPD 患者的临床结局。
方法
在一家专门治疗 COPD 的诊所进行了一项单中心、回顾性队列观察研究，该研究具有历史干预。对确诊为 COPD 的患者进行 IMDM 治疗，并在初始和随访时测量 BODE 评分。主要结局是接受 IMDM 后 BODE 四分位距的动态变化。
结果
在 124 名患者中，有 21%被误诊为 COPD。确诊为 COPD 的患者中，女性占 50%，中位年龄 64 岁（IQR 57-70），43%为主动吸烟者，初始访视时 BODE 四分位距中位数为 2（IQR 1-3）。根据 BODE 四分位距的变化，将患者分为 3 个亚组：恶化组（21%）、不变组（55%）和改善组（24%）。在基线时，改善组的 mMRC（中位数[IQR]）高于恶化组和不变组（3[3,4]比 2[1,2]比 2[1,3]，p 值<0.002）。恶化组所有 BODE 评分的指标均下降，但改善组的 mMRC 显著改善，同时保留了肺功能值。在随访期间，吸烟率从 39%降至 26%。
结论
我们的研究表明，IMDM 可能对 COPD 患者的亚组有效。在其他患者中，随着 BODE 四分位距的恶化，肺功能、活动耐量和主观症状急剧下降似乎不可避免。
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