Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
KITE, Toronto Rehab-University Health Network, Toronto, ON, Canada.
Ann Palliat Med. 2023 Mar;12(2):324-335. doi: 10.21037/apm-22-905.
Lung transplant (LTx) candidates experience significant respiratory symptoms often necessitating palliative care (PC) support. We aimed to describe symptoms experienced by interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) LTx candidates referred for PC using the Edmonton Symptom Assessment System (ESAS) and to assess the change in ESAS in relation to pre-LTx exercise capacity, oxygen requirements, and respiratory exacerbations. Understanding symptom trajectory of these two patient groups will help inform PC management.
Single centre, retrospective cohort of 102 ILD and 24 COPD LTx candidates who were assessed in the Toronto Transplant PC Clinic (TPCC) from 2014-2017. Chi-square and t-tests were used to compare clinical characteristics, physiological parameters, and ESAS scores.
The most common symptom in ILD and COPD patients was dyspnea (median score of 8, cough 7, fatigue 6). ILD patients reported higher cough scores (7 vs. 4, P<0.001). There was no association between the change in ESAS domains and six-minute walk distance (6MWD), oxygen requirements, or respiratory exacerbations, despite increased oxygen requirements and a greater decline in 6MWD in ILD compared to COPD pre-LTx (-47 vs. -8 meters, P=0.01). ILD candidates who were delisted/died compared to those transplanted, experienced worse depression (median ESAS; 4.5 vs. 1), anxiety (5.5 vs. 2) and dyspnea (9.5 vs. 8); P<0.05.
ILD patients had similar symptoms as COPD patients, despite increased oxygen requirements and decreasing 6MWD pre-LTx. This study highlights the importance of symptom management of LTx candidates co-managed with PC, independent of traditional measures of disease severity.
肺移植（LTx）患者常出现严重的呼吸系统症状，需要姑息治疗（PC）支持。我们旨在描述接受 PC 转诊的间质性肺疾病（ILD）和慢性阻塞性肺疾病（COPD）LTx 患者使用埃德蒙顿症状评估系统（ESAS）评估的症状，并评估 ESAS 与 LTx 前运动能力、氧气需求和呼吸恶化的变化。了解这两组患者的症状轨迹将有助于指导 PC 管理。
2014 年至 2017 年，在多伦多移植姑息治疗诊所（TPCC）对 102 例 ILD 和 24 例 COPD LTx 患者进行了单中心回顾性队列研究。采用卡方检验和 t 检验比较临床特征、生理参数和 ESAS 评分。
ILD 和 COPD 患者最常见的症状是呼吸困难（中位数为 8 分，咳嗽 7 分，疲劳 6 分）。ILD 患者报告的咳嗽评分更高（7 分 vs. 4 分，P<0.001）。尽管 LTx 前 ILD 患者的氧气需求增加，6MWD 下降更大（-47 米 vs. -8 米，P=0.01），但 ESAS 各领域的变化与 6MWD、氧气需求或呼吸恶化均无相关性。与移植相比，被取消资格/死亡的 ILD 患者经历了更严重的抑郁（中位数 ESAS；4.5 分 vs. 1 分）、焦虑（5.5 分 vs. 2 分）和呼吸困难（9.5 分 vs. 8 分）；P<0.05。
ILD 患者与 COPD 患者的症状相似，尽管 LTx 前的氧气需求增加，6MWD 下降。这项研究强调了对 LTx 候选者进行症状管理的重要性，这与传统的疾病严重程度衡量标准无关。
