Respiratory Symptoms Items from the COPD Assessment Test Identify Ever-Smokers with Preserved Lung Function at Higher Risk for Poor Respiratory Outcomes An Analysis of the Subpopulations and Intermediate Outcome Measures in COPD Study Cohort
Respiratory Symptoms Items from the COPD Assessment Test Identify Ever-Smokers with Preserved Lung Function at Higher Risk for Poor Respiratory Outcomes An Analysis of the Subpopulations and Intermediate Outcome Measures in COPD Study Cohort
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DOI：
10.1513/annalsats.201610-815oc
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发表时间：
2017-05-01
影响因子：
8.3
通讯作者：
Han, MeiLan K.
中科院分区：
文献类型：
--
作者：
Martinez, Carlos H.;Murray, Susan;Han, MeiLan K.
基本原理：COPD评估测试（CAT）中气流阻塞评分不大于或等于10分的长期吸烟者仍频繁发生急性呼吸道疾病事件（加重样）、运动能力受损和影像学异常。这些主题的识别可以提供新的机会，有针对性的interventions.Objectives：我们假设，四个相关的项目的CAT可能是有用的识别这样的个人，与区分能力类似的CAT，这是一个八项问卷，用于评估慢性阻塞性肺疾病的影响，包括非呼吸问题，得分范围从0到40。方法：我们评估了COPD研究中亚群和中间结果的吸烟者，无气流阻塞（FEV 1/FVC >= 0.70; FVC高于正常下限）。使用受试者工作特征曲线下面积，我们比较了对CAT和呼吸道疾病相关CAT项目（咳嗽、痰、胸闷和呼吸困难）的反应及其与纵向加重的相关性。我们测试了两种策略之间的一致性（kappa统计量），我们比较了人口统计学，肺功能，和症状之间的主题确定为有高症状的每一个策略。（平均年龄61岁; 52%的女性），并使用CAT临界点大于或等于10，我们将51.8%的个体归类为具有高度症状，15.3%的患者在1年随访期间至少发生一次急性加重。在测试了前四个问题的不同评分的敏感性和特异性以预测任何1年随访加重后，我们选择0-6分作为代表低症状负担的临界点，而7分或更高分数则代表所有后续比较的高症状负担。临界点大于或等于7的4个与疾病相关的项目选择了45.8%的参与者，其中15.6%的参与者在随访期间至少经历了一次急性加重。这两种策略在很大程度上识别出了相同的个体（一致率88.5%，kappa = 0.77; P< 0.001），并且在CAT和前四个CAT问题之间，具有严重呼吸困难的高症状受试者的比例相似（分别为25.9%和26.8%），报告生活质量受损的比例也是如此。（分别为66.9%和70.5%）和步行距离短（分别为22.4%和23.1%）。预测1年随访急性加重的受试者工作特征曲线下面积无差异（CAT评分>= 10，0.66;与CAT评分>= 7的4个呼吸项目，0.65; P = 0.69）。受试者通过任何一种方法也有更多的抑郁/焦虑症状，睡眠质量差，和更大的fatigue.Conclusions：四个CAT项目的呼吸道症状确定高风险的有症状的吸烟者保留肺功能测定以及CAT没有。这些数据表明，可以制定更简单的策略，以确定这些高风险的个人在初级保健。
Rationale: Ever-smokers without airflow obstruction scores greater than or equal to 10 on the COPD Assessment Test (CAT) still have frequent acute respiratory disease events (exacerbation-like), impaired exercise capacity, and imaging abnormalities. Identification of these subjects could provide new opportunities for targeted interventions.Objectives: We hypothesized that the four respiratory-related items of the CAT might be useful for identifying such individuals, with discriminative ability similar to CAT, which is an eight-item questionnaire used to assess chronic obstructive pulmonary disease impact, including nonrespiratory questions, with scores ranging from 0 to 40.Methods: We evaluated ever-smoker participants in the Subpopulations and Intermediate Outcomes in COPD Study without airflow obstruction (FEV1/FVC >= 0.70; FVC above the lower limit of normal). Using the area under the receiver operating characteristic curve, we compared responses to both CAT and the respiratory symptom-related CAT items (cough, phlegm, chest tightness, and breathlessness) and their associations with longitudinal exacerbations. We tested agreement between the two strategies (kappa statistic), and we compared demographics, lung function, and symptoms among subjects identified as having high symptoms by each strategy.Results: Among 880 ever-smokers with normal lung function (mean age, 61 yr; 52% women) and using a CAT cutpoint greater than or equal to 10, we classified 51.8% of individuals as having high symptoms, 15.3% of whom experienced at least one exacerbation during 1-year follow-up. After testing sensitivity and specificity of different scores for the first four questions to predict any 1-year followup exacerbation, we selected cutpoints of 0-6 as representing a low burden of symptoms versus scores of 7 or higher as representing a high burden of symptoms for all subsequent comparisons. The four respiratory-related items with cutpoint greater than or equal to 7 selected 45.8% participants, 15.6% of whom experienced at least one exacerbation during follow-up. The two strategies largely identified the same individuals (agreement, 88.5%; kappa = 0.77; P< 0.001), and the proportions of high-symptoms subjects who had severe dyspnea were similar between CAT and the first four CAT questions (25.9% and 26.8%, respectively), as were the proportions reporting impaired quality of life (66.9% and 70.5%, respectively) and short walking distance (22.4% and 23.1%, respectively). There was no difference in area under the receiver operating characteristic curve to predict 1-year follow-up exacerbations (CAT score >= 10, 0.66; vs. four respiratory items from CAT >= 7 score, 0.65; P = 0.69). Subjects identified by either method also had more depression/anxiety symptoms, poor sleep quality, and greater fatigue.Conclusions: Four CAT items on respiratory symptoms identified high-risk symptomatic ever-smokers with preserved spirometry as well as the CAT did. These data suggest that simpler strategies can be developed to identify these high-risk individuals in primary care.