Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Medicine and Department of Physiology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California.
Ann Am Thorac Soc. 2022 Feb;19(2):171-178. doi: 10.1513/AnnalsATS.202009-1187OC.
Individuals with chronic obstructive pulmonary disease (COPD) have a high prevalence of depression, which is associated with increased COPD hospitalizations and readmissions. Examine the impact of depressive symptoms compared with FEV% on COPD morbidity. Using longitudinal data from individuals with COPD in the Subpopulations and Intermediate Outcome Measures in COPD Study, longitudinal growth analysis was performed to assess COPD morbidity by assessing differences in baseline 6-minute walk distance and patient reported outcomes (PROs) and their rate of change over time explained by depressive symptoms or lung function, as measured by Hospital Anxiety and Depression Scale or FEV% respectively. PROs consisted of in-person completion of St. George's Respiratory Questionnaire, COPD Assessment Test, Functional Assessment of Chronic Illness Therapy Fatigue, and Modified Medical Research Council Dyspnea Scale measures. Of the individuals analyzed ( = 1,830), 43% were female, 81% Caucasian with mean ± SD age of 65.1 ± 8.1, and 52.7 ± 27.5 pack-years smoking. Mean ± SD FEV% was 60.9 ± 23.0% and 20% had clinically significant depressive symptoms. Adjusted models showed higher Hospital Anxiety and Depression Scale scores and lower FEV% each were associated with worse PROs at baseline ( ⩽ 0.001). Depression accounted for more baseline variance in St. George's Respiratory Questionnaire, COPD Assessment Test, and Functional Assessment of Chronic Illness Therapy Fatigue than FEV%, explaining 30-67% of heterogeneity. FEV% accounted for more baseline variance in Modified Medical Research Council Dyspnea Scale and 6-minute walk distance than depression, explaining 16-32% of heterogeneity. Depressive symptoms accounted for 3-17% variance in change over time in PROs. In contrast, FEV% accounted for 1-4% variance over time in PROs. Depression is more strongly associated with many PROs at baseline and their change over time compared with FEV%. Recognizing and incorporating the impact of depressive symptoms into individualized care may improve COPD outcomes.
慢性阻塞性肺疾病（COPD）患者的抑郁患病率较高，与 COPD 住院率和再入院率增加有关。研究比较抑郁症状与 FEV%对 COPD 发病率的影响。利用 COPD 亚人群和中间结局测量研究中 COPD 患者的纵向数据，通过评估基线 6 分钟步行距离和患者报告结局（PROs）的差异，以及分别使用医院焦虑抑郁量表（HADS）或 FEV%测量的抑郁症状或肺功能随时间的变化率，进行纵向增长分析，以评估 COPD 发病率。PROs 包括面对面完成圣乔治呼吸问卷（SGRQ）、COPD 评估测试（CAT）、慢性疾病治疗疲劳功能评估量表（FACIT-Fatigue）和改良医学研究委员会呼吸困难量表（mMRC-Dyspnea Scale）。在分析的个体中（ = 1830），43%为女性，81%为白种人，平均年龄 65.1 ± 8.1 岁，吸烟 52.7 ± 27.5 包年。平均 ± SD FEV%为 60.9 ± 23.0%，20%有临床显著的抑郁症状。调整模型显示，HADS 评分较高和 FEV%较低与基线时 PROs 较差相关（ ⩽ 0.001）。抑郁症状比 FEV%更能解释 SGRQ、CAT 和 FACIT-Fatigue 的更大基线变异性，占异质性的 30-67%。FEV%比抑郁症状更能解释 mMRC-Dyspnea Scale 和 6 分钟步行距离的更大基线变异性，占异质性的 16-32%。抑郁症状占 PROs 随时间变化的 3-17%的变异性。相比之下，FEV%占 PROs 随时间变化的 1-4%的变异性。与 FEV%相比，抑郁症状与许多 PROs 的基线水平及其随时间的变化更密切相关。认识到并将抑郁症状的影响纳入个体化治疗可能会改善 COPD 结局。
