The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD
The Relationship Between Morning Symptoms and the Risk of Future Exacerbations in COPD
复制标题
早晨症状与慢性阻塞性肺病未来恶化风险之间的关系
DOI：
10.2147/copd.s255030
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发表时间：
2020-01-01
影响因子：
2.8
通讯作者：
Chen，Ping
中科院分区：
文献类型：
--
作者：
Sun，Tian;Li，Xiaoyun;Chen，Ping
背景：对于慢性阻塞性肺疾病(COPD)患者来说，早晨是一天中最麻烦的时间。然而，在纵向随访中，晨间症状和COPD恶化之间的相关性尚未被研究。在这项研究中，我们主要目的是在一年的随访期内调查晨间症状和恶化之间的关系。次要目的是调查晨间症状和基线临床特征之间的关系。患者和方法92例稳定期COPD患者提供基线资料。用中国版慢性阻塞性肺疾病晨间症状日记(CH-COPD-MSD)评定晨间症状；以晨间症状评分中位数为界值划分两组研究队列。采用改良医学研究委员会(MMRC)、COPD评估试验(CAT)和临床COPD问卷(CCQ)，记录上一年的急性加重史。78例(84.8%)患者完成了病情加重的纵向随访。结果稳定期COPD患者晨间症状评分中位数为30分。慢性阻塞性肺疾病全球倡议(GOLD)组的晨间症状严重程度不同(P<；0.001)。晨间症状高(30分)的患者MMRC、CAT和CCQ得分较高(P<；0.05)。CAT评分是晨间症状的独立危险因素。在随访期间，41%的患者经历了≥-1恶化。晨间症状多的患者与晨间症状少的患者相比，严重恶化的频率更高(p<；0.005)。CH-COPD-MSD评分可以预测未来的严重恶化；ROC曲线下面积为0.751(95%CI：0.633-0.868，P=0.002)。结论健康状况越差，呼吸困难症状越多，晨间症状越严重。晨间症状与COPD患者未来的严重恶化密切相关，并可以预测未来的恶化。
Background The morning is the most troublesome time of day for patients with chronic obstructive pulmonary disease (COPD). However, the association of morning symptoms and COPD exacerbations in longitudinal follow-up has not been studied. In this study, we mainly aimed to investigate the relationship between morning symptoms and exacerbations over a one-year follow-up period. And the secondary aim was an investigation of the association between morning symptoms and baseline clinical features. Patients and Methods Ninety-two patients with stable COPD provided the baseline information. Morning symptoms were assessed with the Chinese version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD); the median morning symptoms score was used as a cut-off to separate the study cohort in two groups. Modified Medical Research Council (mMRC), COPD assessment test (CAT), and Clinical COPD Questionnaire (CCQ) were used and exacerbation history of the previous year was recorded. Seventy-eight patients (84.8%) completed the longitudinal follow-up of exacerbations. Results The median morning symptoms score was 30 in stable COPD patients. Morning symptoms severity was different between COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups (p<0.001). Patients with high morning symptoms (score > 30) had higher scores of mMRC, CAT, and CCQ (p< 0.05). CAT score was an independent risk factor of morning symptoms. During follow-up, 41% of patients experienced ≥1 exacerbation. The frequency of severe exacerbations was higher in patients with high morning symptoms compared to patients with low morning symptoms (p<0.005). The Ch-COPD-MSD score could predict future severe exacerbations; the area under the ROC curve was 0.751 (95% CI: 0.633–0.868, p=0.002). Conclusion Worse health status and more dyspnea symptom were associated with increased severity of morning symptoms. Morning symptoms were most strongly related to future severe exacerbations and could predict future exacerbations in patients with COPD.