Heterogeneity in the respiratory symptoms of patients with mild-to-moderate COPD
Heterogeneity in the respiratory symptoms of patients with mild-to-moderate COPD
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DOI：
10.2147/copd.s184424
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发表时间：
2018-01-01
影响因子：
2.8
通讯作者：
Sadatsafavi, Mohsen
中科院分区：
文献类型：
--
作者：
Johnson, Kate M.;Safari, Abdollah;Sadatsafavi, Mohsen
背景：慢性阻塞性肺病患者的症状负担差异显著，与肺功能损害的相关性较弱。虽然以前研究过肺功能下降和恶化的异质性，但症状的异质性程度以及与这种异质性相关的因素尚未得到很好的了解。方法：对加拿大普通人群>= 40岁持续气流受限患者进行长达3年的随访。参与者每隔18个月报告一次他们是否有慢性咳嗽、痰、喘息或呼吸困难的症状。我们使用混合效应逻辑回归模型（每种症状单独）来评估个体之间症状发生的总体异质性，以及由肺功能解释的症状负担变化与参与者所有其他临床特征的比例。结果：449名参与者（53%为男性，平均年龄67岁）共就诊968次，89%的患者在随访期间报告了至少一种症状。出现症状的个体特异性概率存在很大的异质性。这种异质性在喘息和呼吸困难中最高（概率IQR分别为0.13-0.78和0.19-0.81）。FEV1解释了个体之间28%的呼吸困难、8%的痰、3%的咳嗽和2%的喘息。参与者的所有临床特征（包括FEV1）解释了咳嗽发生率的26%和呼吸困难发生率的49%之间的异质性。结论：慢性阻塞性肺病患者呼吸道症状负担存在明显的异质性。肺功能的能力和其他通常测量的临床特征来解释这种异质性在不同症状之间的差异。
Background: The burden of symptoms varies markedly between patients with COPD and is only weakly correlated with lung function impairment. While heterogeneity in lung function decline and exacerbations have been previously studied, the extent of heterogeneity in symptoms and the factors associated with this heterogeneity are not well understood.Methods: A sample of the general Canadian population >= 40 years with persistent airflow limitation was followed for up to 3 years. Participants reported whether they experienced chronic coughing, phlegm, wheezing, or dyspnea during visits at 18-month intervals. We used mixed-effect logistic regression models (separately for each symptom) to assess overall heterogeneity in the occurrence of symptoms between individuals, and the proportion of variation in symptom burden explained by lung function vs all other clinical characteristics of participants.Results: Four hundred forty-nine participants (53% male, mean age 67 years) contributed 968 visits in total, and 89% of patients reported at least one symptom during follow-up. There was substantial heterogeneity in the individual-specific probabilities for the occurrence of symptoms. This heterogeneity was highest for wheeze and dyspnea (IQR of probabilities: 0.13-0.78 and 0.19-0.81, respectively). FEV1 explained 28% of the variation between individuals in the occurrence of dyspnea, 8% for phlegm, 3% for cough, and 2% for wheeze. All clinical characteristics of participants (including FEV1) explained between 26% of heterogeneity in the occurrence of cough to 49% for dyspnea.Conclusion: There is marked heterogeneity in the burden of respiratory symptoms between COPD patients. The ability of lung function and other commonly measured clinical characteristics to explain this heterogeneity differs between symptoms.