Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD
Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD
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DOI：
10.1378/chest.121.5.1434
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发表时间：
2002-05-01
期刊：
影响因子：
9.6
通讯作者：
Oga, T
中科院分区：
文献类型：
--
作者：
Nishimura, K;Izumi, T;Oga, T
背景资料：FEV1被认为是COPD生存率的最重要相关因素，并在COPD分期中用作疾病严重程度的衡量标准。然而，最近，根据呼吸困难水平对COPD患者进行分类同样被报道可用于预测健康相关的生活质量和肺康复后运动表现的改善。研究目的：我们比较了呼吸困难水平和疾病严重程度（通过气道阻塞评估）对COPD患者5年生存率的影响。设计和方法：共227例COPD患者参加了为期5年的，前瞻性的，多中心的研究在日本关西地区，涉及20个部门的呼吸内科从各个大学和城市hospital.Results：5年后，183例患者可进行随访检查（随访率，81%）。COPD患者的5年累积生存率为73%。根据美国胸科学会（ATS）指南，通过预测FEV1的百分比评估疾病分期对5年生存率的影响不显著（p = 0.08）。呼吸困难程度与5年生存率有显著相关性（P < 0.001）。考克斯比例风险模型显示，呼吸困难程度对生存率的影响比基于FEV1的疾病严重程度更显著。结论：在5年生存率方面，基于呼吸困难程度的COPD患者分类比ATS指南的疾病严重程度分期更有鉴别力。除了气道阻塞外，呼吸困难应作为评估COPD患者死亡率的变量之一。
Background: FEV1 is regarded as the most significant correlate of survival in COPD and is used as a measure of disease severity in the staging of COPD. Recently, however, the categorization of patients with COPD on the basis of the level of dyspnea has similarly been reported to be useful in the prediction of health-related quality of life and improvement in exercise performance after pulmonary rehabilitation.Study objectives: We compared the effects of the level of dyspnea and disease severity, as evaluated by airway obstruction, on the 5-year survival rate of patients with COPD. Design and methods: A total of 227 patients with COPD were enrolled in a 5-year, prospective, multicenter study in the Kansai area of Japan, involving 20 divisions of respiratory medicine from various university and city hospitals.Results: After 5 years, 183 patients were available for the follow-up examination (follow-up rate, 81%). The 5-year cumulative survival rate among patients with COPD was 73%. The effect of disease staging, based on the American Thoracic Society (ATS) guideline as evaluated by the percentage of predicted FEV1, on the 5-year survival rate was not significant (p = 0.08). However, the level of dyspnea was significantly con-elated to the 5-year survival rate (p < 0.001). The Cox proportional hazards model revealed that the level of dyspnea had a more significant effect on survival than disease severity based on FEV1.Conclusions: The categorization of patients with COPD on the basis of the level of dyspnea was more discriminating than staging of disease severity using the ATS guideline with respect to 5-year survival. Dyspnea should be included as one of the variables, in addition to airway obstruction, for evaluating patients with COPD in terms of mortality.