Disability and Health Outcomes in COPD

简介(申请人提供)：背景。COPD是一种常见的慢性健康疾病。由于目前的医疗治疗对疾病进展的影响微乎其微，因此预防COPD相关残疾的战略将具有重要的临床和公共卫生好处。 研究目的。为了阐明残疾的过程，我们将测试一个特定的概念模型，说明残疾是如何在COPD中发展的。其目的是：(1)评估呼吸损害，尤其是肺功能损害对COPD患者功能受限风险的影响。使用对照组，阐明直接可归因于COPD的呼吸损害、功能受限和残疾的患病率。(2)在成人COPD患者中，描述功能限制对意外残疾风险的纵向影响。我们假设功能受限的发展，而不是肺功能损害，是残疾的主要决定因素。(3)确定残疾对未来不良健康后果风险的预期影响。 方法：研究方法。我们将收集1200名随机抽样的患有COPD的成年人的前瞻性队列，他们是一个大型地区性健康维护组织的成员。将招募300名受试者作为匹配的对照组。受试者将接受详细的身体评估，以衡量呼吸损害(例如，肺功能)和功能限制(例如，下肢功能、肌肉力量、运动表现和认知功能)。结构化电话访谈将确定基线的残疾结果和18个月的预期后续行动。我们还将研究特定的风险因素和保护因素在从功能限制到COPD相关残疾进展过程中的调节作用，包括心理因素、环境暴露和医疗保健过程因素。 意义重大。阐明残疾过程是设计旨在减少COPD残疾的临床和公共卫生干预措施的第一步。通过确定从功能受限到残疾的途径，我们的目标是为COPD患者的残疾筛查和预防提供科学依据。基于这项工作，可以设计以减少功能限制和残疾为目标的干预策略，以改善下游的健康结果。

DESCRIPTION (provided by applicant): Background. COPD is a common chronic health condition. Because current medical treatments have minimal impact on disease progression, a strategy to prevent COPD-related disability would have important clinical and public health benefits. Study Aims. To elucidate the disablement process, we will test a specific conceptual model of how disability develops in COPD. The aims are: (1) To evaluate the impact of respiratory impairment, especially pulmonary function impairment, on the risk of functional limitation in COPD. Using a control group, to elucidate the prevalence of respiratory impairment, functional limitation, and disability that is directly attributable to COPD. (2) In adults with COPD, to delineate the longitudinal effect of functional limitation on the risk of incident disability. We hypothesize that development of functional limitation, and not pulmonary function impairment, is the major determinant of disability. (3) To determine the prospective impact of disability on the risk of future adverse health outcomes. Methods. We will assemble a prospective cohort of 1200 randomly sampled adults with COPD who are members of a large regional health maintenance organization. A matched control group of 300 subjects will be recruited. Subjects will undergo a detailed physical assessment that measures respiratory impairment (e.g., pulmonary function) and functional limitation (e.g., lower extremity function, muscle strength, exercise performance, and cognitive function). Structured telephone interviews will ascertain disability outcomes at baseline and 18-month prospective follow-up. We will also study the modulating effects of specific risk factors and protective factors on the progression from functional limitation to COPD-related disability, including psychological factors, environmental exposures, and health care process factors. Significance. Elucidation of the disablement process is the first step toward designing clinical and public health interventions that target reduction of disability in COPD. By determining the pathway from functional limitation to disability, our goal is to provide a scientific basis for screening and prevention of disability among persons with COPD. Based on this work, intervention strategies can be designed that target reduction of functional limitation and disability to improve downstream health outcomes.