IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia; Wolfson Palliative Care Research Centre, University of Hull, Hull, England.
Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Sydney, New South Wales, Australia.
J Pain Symptom Manage. 2020 Oct;60(4):818-827.e4. doi: 10.1016/j.jpainsymman.2020.05.015. Epub 2020 May 20.
Chronic breathlessness is associated with poorer quality of life (QoL). This population study aimed to define dimensions of QoL and duration and dominant causes of breathlessness that most diminished QoL.
This cross-sectional, population-based, and randomized survey of adults (n = 2977) in South Australia collected data on demographics, modified Medical Research Council (mMRC) breathlessness, and QoL (EuroQoL five-dimension five-level [EQ-5D-5L] measure; Short Form 12 quality-of-life measure). Data weighted to the census were analyzed for relationships between EQ-5D-5L and its dimensions with mMRC. Regression models controlled for age, sex, education, rurality, and body mass index.
About 2883 responses were analyzed: 49% were males; mean age was 48 years (SD 19). As mMRC worsened, EQ-5D-5L and its dimensions worsened. More severe chronic breathlessness was iteratively associated with lower mobility, daily activities, and worse pain/discomfort. For self-care and anxiety/depression, impairment was only with the most severe breathlessness. Respondents who had chronic breathlessness for two to six years had the worst QoL scores. People who attributed their breathlessness to cardiac failure had poorer QoL. Respondents who reported a cardiac cause for their breathlessness had worse mobility, poorer usual activities, and more pain than the other causes. The regression analyses showed that worse chronic breathlessness was associated with worsening QoL in each dimension of EQ-5D-5L, with the exception of the self-care, which only worsened with the most severe breathlessness.
This is the first study to report on chronic breathlessness and impairment across dimensions of QoL and differences by its duration. Mobility, usual activity, and pain drive these reductions.
慢性呼吸困难与较差的生活质量（QoL）相关。本项人群研究旨在确定对 QoL 影响最大的维度、呼吸困难的持续时间和主要病因。
本项横断面、基于人群的随机调查纳入了南澳大利亚的成年人（n=2977），收集了人口统计学资料、改良的医学研究委员会（mMRC）呼吸困难量表和生活质量（EQ-5D-5L 量表；SF-12 生活质量量表）数据。对数据进行了加权处理以与人口普查数据相匹配，分析了 EQ-5D-5L 及其各维度与 mMRC 之间的关系。回归模型控制了年龄、性别、教育程度、农村与城市分布情况以及体重指数。
对约 2883 份回复进行了分析：49%为男性；平均年龄为 48 岁（标准差 19 岁）。随着 mMRC 恶化，EQ-5D-5L 及其各维度的评分也随之恶化。更严重的慢性呼吸困难与较低的移动性、日常活动能力以及更严重的疼痛/不适相关。对于自理能力和焦虑/抑郁，仅在最严重的呼吸困难时出现障碍。慢性呼吸困难持续 2 至 6 年的患者 QoL 评分最差。将呼吸困难归因于心衰的患者 QoL 较差。报告呼吸困难由心力衰竭引起的患者在移动性、日常活动能力方面更差，且疼痛程度更重，与其他病因相比。回归分析显示，随着慢性呼吸困难恶化，EQ-5D-5L 的每个维度的 QoL 均恶化，自理能力除外，仅在最严重的呼吸困难时恶化。
这是第一项报告慢性呼吸困难对 QoL 各维度影响以及不同持续时间的差异的研究。移动性、日常活动和疼痛是导致这些下降的主要因素。
