Department of Physiotherapy, Vocational School of Health Services, Izmir University of Economics, Izmir, Turkey.
Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey.
Respir Care. 2021 Mar;66(3):442-448. doi: 10.4187/respcare.07794. Epub 2020 Sep 8.
Although FEV and FEV/FVC are accepted as standard parameters in treatment follow-up, these parameters have a limited ability to predict clinical outcomes in patients with COPD. However, small airways dysfunction, which is determined by maximum mid-expiratory flow, is variable in the same stage of patients with COPD, even if their FEV and FEV/FVC are similar. The aim of this study was to compare pulmonary function, the severity of perceived dyspnea, the severity of fatigue, physical activity level, and health-related quality of life based on the severity of small airways dysfunction in male subjects with moderate COPD.
The study consisted of 96 subjects with moderate COPD. Pulmonary function tests, the distance achieved on the 6-min walk test, the modified Medical Research Council Dyspnea Scale, the International Physical Activity Questionnaire - short form, the Fatigue Severity Scale, the St George Respiratory Questionnaire, and Short Form 36 questionnaire were evaluated in all subjects. After calculating the mean percent of predicted maximum mid-expiratory flow for the entire sample, subjects were divided into 2 groups: below average (Group 1, = 54 subjects) and above average (Group 2, = 42 subjects).
There were no differences between the groups in age, body mass index, cigarette consumption, percent of predicted FEV, and FEV/FVC ( = .55, .61, .19, .09, and .15, respectively). Scores from the Fatigue Severity Scale and the modified Medical Research Council dyspnea scale were significantly higher in Group 1 ( = .003 and = .002, respectively); in addition, results from the 6-min walk test and the International Physical Activity Questionnaire - short form scores were significantly lower ( = .001 and < .001, respectively).
Increased small airways dysfunction led to increased perception of dyspnea and fatigue, as well as poor exercise capacity and health-related quality of life in male subjects with COPD. We suggest that it may be useful to consider the maximum mid-expiratory flow in addition to FEV and FEV/FVC in the treatment and follow-up of male patients with moderate COPD.
虽然 FEV 和 FEV/FVC 被认为是治疗随访中的标准参数，但这些参数在预测 COPD 患者的临床结局方面能力有限。然而，小气道功能障碍，由最大中期呼气流量决定，在 COPD 患者的同一阶段是可变的，即使他们的 FEV 和 FEV/FVC 相似。本研究旨在比较男性中度 COPD 患者根据小气道功能障碍严重程度的肺功能、感知呼吸困难的严重程度、疲劳严重程度、身体活动水平和健康相关生活质量。
该研究包括 96 名男性中度 COPD 患者。对所有患者进行肺功能检查、6 分钟步行试验的距离、改良医学研究委员会呼吸困难量表、国际体力活动问卷-短表、疲劳严重程度量表、圣乔治呼吸问卷和简短形式 36 问卷进行评估。在计算整个样本的最大中期呼气流量平均预测百分比后，将患者分为两组：低于平均水平（组 1，=54 例）和高于平均水平（组 2，=42 例）。
两组在年龄、体重指数、吸烟量、FEV 预测百分比和 FEV/FVC 方面无差异（=0.55、0.61、0.19、0.09 和 0.15）。组 1 的疲劳严重程度量表和改良医学研究委员会呼吸困难量表评分明显更高（=0.003 和 0.002）；此外，6 分钟步行试验和国际体力活动问卷-短表评分明显较低（=0.001 和 <0.001）。
小气道功能障碍增加导致男性 COPD 患者呼吸困难和疲劳的感知增加，以及运动能力和健康相关生活质量下降。我们建议，在治疗和随访男性中度 COPD 患者时，除了 FEV 和 FEV/FVC 外，还可以考虑最大中期呼气流量。
