Alfano Pietro, Cuttitta Giuseppina, Audino Palma, Fazio Giovanni, La Grutta Sabina, Marcantonio Salvatore, Bucchieri Salvatore
Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy.
Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy.
J Clin Med. 2022 Jan 27;11(3):656. doi: 10.3390/jcm11030656.
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner's surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40-88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health "PCS" and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with ( < 0.001) and without AO ( < 0.001); mMRC and PCS were inversely related in subjects with ( = 0.001) and without AO ( < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient's global health.
众所周知，在基层医疗环境中，多种疾病并存会损害患者的生活质量（QoL）。生活质量差与更高的呼吸困难感知相关。多种疾病并存和呼吸困难感知如何与生活质量相关尚需阐明。本研究的目的是评估在基层医疗环境中，有气流受限和无气流受限的成年人中，呼吸困难感知在多种疾病并存与生活质量之间关系中的中介作用。17名全科医生参与了该研究：共有912名成年患者因普通会诊前往医生诊所就诊，完成了初步的呼吸筛查；其中566人在2014年1月至6月期间回答了一份呼吸问卷，后者中的259人（148名男性，年龄40 - 88岁）同意接受所有检查程序，包括肺活量测定、IMCA以及生活质量（通过身体健康“PCS”和心理健康分量表的SF - 36）问卷、合并症评估和mMRC呼吸困难量表。为了进行筛查，FEV/FVC < 70%的临界值被视为气流受限（AO）的标志。在样本中，25%表现出气流受限（AO）。在有和无AO的受试者之间，关于合并症数量和PCS的mMRC评分没有显著差异。在有（< 0.001）和无AO（< 0.001）的受试者中，多种疾病并存与PCS呈负相关；在有（= 0.001）和无AO（< 0.001）的受试者中，mMRC与PCS呈负相关。一项中介分析表明，在有AO的受试者中，合并症数量与PCS之间的关系完全由mMRC介导，在无AO的受试者中部分由mMRC介导。我们得出结论，仅在AO中，多种疾病并存对PCS的影响完全由mMRC介导。在基层医疗环境中检测和监测mMRC可能是评估患者整体健康的一个有用指标。
