How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care?
How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care?
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DOI：
10.1016/j.jpainsymman.2022.11.016
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发表时间：
2023-02-10
影响因子：
4.7
通讯作者：
Bekelman，David B.
中科院分区：
文献类型：
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作者：
Lange，Allison V.;Mehta，Anuj B.;Bekelman，David B.
背景为慢性阻塞性肺疾病(COPD)患者提供姑息治疗是当务之急。肺活量测定显示气流受限是慢性阻塞性肺疾病的诊断试验，也是姑息治疗研究的常见纳入标准。然而，要求有气流限制的肺活量测定可能会排除不能完成肺活量测定的适当患者，或者与COPD一致的保留比率受损的肺活量测定和症状或成像的患者。方法：确定根据国际疾病分类(ICD)代码确定的COPD患者和仅与ICD代码相比有气流限制的COPD患者之间在生活质量(QOL)和症状方面的差异。干预：纳入参加姑息治疗试验的COPD患者。患者住院和死亡的风险很高，报告的生活质量很差。比较两组患者的基本生活质量(癌症治疗功能评估(FACT-G)、临床COPD问卷和生命末期生活质量)和症状(患者健康问卷-8、广泛性焦虑症-7、疲劳、失眠严重指数)。结果208名COPD患者主要为男性，白人，平均年龄为68.4岁。有ICD编码的患者和有气流受限的肺活量测定患者与仅有ICD编码的患者相比，在FACT-G(59.0vs.55.0，P=0.33)、其他生活质量测量或症状方面没有显著差异。结论这些结果表明，对于生活质量较差和不良结果风险较高的患者，肺活量测定可能不需要作为姑息治疗研究或临床护理的一项要求。
BackgroundProviding palliative care to patients with chronic obstructive pulmonary disease (COPD) is a priority. Spirometry demonstrating airflow limitation is a diagnostic test for COPD and a common inclusion criterion for palliative care research. However, requiring spirometry with airflow limitation may exclude appropriate patients unable to complete spirometry, or patients with preserved-ratio impaired spirometry and symptoms or imaging consistent with COPD.MeasuresTo determine differences in quality of life (QOL) and symptoms between patients with COPD identified based on International Classification of Diseases (ICD) codes and spirometry with airflow limitation compared to ICD codes only.InterventionPatients with COPD enrolled in a palliative care trial were included. Patients were at high risk of hospitalization and death and reported poor QOL. Baseline measures of QOL (Functional Assessment of Cancer Therapy–General (FACT-G), the Clinical COPD Questionnaire, and Quality of Life at the End of Life), and symptoms (Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, fatigue, Insomnia Severity Index) were compared.OutcomesTwo hundred eight patients with COPD were predominantly male, White, and average age was 68.4. Between patients with ICD codes and spirometry with airflow limitation compared to patients with ICD codes only, there were no significant differences in FACT-G (59.0 vs. 55.0,P= 0.33), other measures of QOL, or symptoms between groups.ConclusionThese results imply that spirometry may not need to be a requirement for inclusion into palliative care research or clinical care for patients with poor quality of life and at high risk for adverse outcomes.