识别慢性阻塞性肺疾病（COPD）患者异常运动性呼吸困难：改良医学研究委员会问卷与COPD评估测试对比心肺运动试验
Identifying Abnormal Exertional Breathlessness in COPD: Comparing Modified Medical Research Council and COPD Assessment Test With Cardiopulmonary Exercise Testing.
作者信息
Ekström Magnus, Lewthwaite Hayley, Li Pei Zhi, Bourbeau Jean, Tan Wan C, Jensen Dennis
机构信息
Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine (M. E.), Faculty of Medicine, Lund University, Lund, Sweden.
Centre of Research Excellence Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia; Asthma and Breathing Research Program (H. L.), Hunter Medical Research Institute, Newcastle, NSW, Australia.
出版信息
Chest. 2025 Mar;167(3):697-711. doi: 10.1016/j.chest.2024.10.027. Epub 2024 Oct 28.
BACKGROUND
COPD management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale, the COPD Assessment Test (CAT), or both.
RESEARCH QUESTION
What are the abilities of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD?
STUDY DESIGN AND METHODS
Analysis of people aged ≥ 40 years with FEV to FVC ratio of < 0.70 after bronchodilator administration and ≥ 10 pack-years of smoking from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg scale 0-10) intensity rating more than the upper limit of normal at the symptom-limited peak of CPET using normative reference equations.
RESULTS
We included 318 people with COPD (40% female) with a mean (SD) age of 66.5 (9.3) years and FEV of 79.5% predicted (19.0% predicted); 26% showed abnormally low exercise capacity (peak oxygen uptake less than the lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC score of 0 and CAT score of < 10, respectively. An mMRC score of ≥ 2 and CAT score of ≥ 10 was most specific (95%) to detect abnormal exertional breathlessness, but showed low sensitivity of only 12%. Accuracy for all scale cutoffs or combinations was < 65%. Compared with people with true-negatives findings, people with abnormal exertional breathlessness but low mMRC score, low CAT scores (false-negatives findings), or both showed worse self-reported and physiologic outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to be taking any respiratory medication (37% vs 30%; mean difference, 6.1%; 95% CI, -7.2 to 19.4; P= .36).
INTERPRETATION
In COPD, mMRC and CAT showed low concordance with CPET and failed to identify many people with abnormally high exertional breathlessness.
CLINICAL TRIAL REGISTRY
ClinicalTrials.gov; No.: NCT00920348; URL: www.
CLINICALTRIALS
gov.
背景
慢性阻塞性肺疾病（COPD）的管理以呼吸症状负担为指导，使用改良的医学研究委员会（mMRC）量表、COPD评估测试（CAT）或两者结合进行评估。
研究问题
mMRC和CAT在检测COPD患者递增心肺循环运动试验（CPET）中异常高的运动性呼吸困难方面的能力如何？
研究设计与方法
对来自加拿大队列性阻塞性肺疾病研究中年龄≥40岁、支气管扩张剂给药后FEV与FVC比值<0.70且吸烟史≥10包年的人群进行分析。异常运动性呼吸困难定义为使用标准参考方程在CPET症状受限峰值时呼吸困难（Borg量表0 - 10）强度评分超过正常上限。
结果
我们纳入了318例COPD患者（40%为女性），平均（标准差）年龄为66.5（9.3）岁，FEV为预测值的79.5%（预测值的19.0%）；26%的患者运动能力异常低（峰值摄氧量低于正常下限）。24%的患者存在异常高的运动性呼吸困难，其中mMRC评分为0的患者中有9%，CAT评分为<10的患者中有11%。mMRC评分≥2且CAT评分≥10对检测异常运动性呼吸困难最具特异性（95%），但敏感性仅为12%，较低。所有量表临界值或组合的准确性均<65%。与真阴性结果的患者相比，运动性呼吸困难异常但mMRC评分低、CAT评分低（假阴性结果）或两者皆有的患者在CPET期间自我报告和生理结果更差，更有可能被医生诊断为COPD，但服用任何呼吸药物的可能性并不更高（37%对30%；平均差异6.1%；95%CI， - 7.2至19.4；P = 0.36）。
解读
在COPD中，mMRC和CAT与CPET的一致性较低，未能识别出许多运动性呼吸困难异常高的患者。
临床试验注册
ClinicalTrials.gov；编号：NCT00920348；网址：www. ClinicalTrials.gov。
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