The Comparative And Applied Research Of IC And FEV1 On Evaluating Dyspnea Symptom In Patients With Chronic Obstructive Pulmonary Disease

Objectives:To compare the value of IC and FEV1 evalutaing dyspnea remission in patients with chronic obstructive pulmonary disease.Methods:The study was conducted by a method of retrospective analysis-prospective cohort study. We collected moderate-extremely severe 180 COPD patients who met the diagnostic criteria according to Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD 2014). All the patients visited Qilu Hospital, Shandong University during December 2014 to April 2015, and their conditions were stable. All the patients were acquired oral informed consent. Study steps:(1) inquired with current conditions, individual history, exacerbation conditions, medicine history, etc; (2) scores for the degree of dyspnea via modified British Medical Research Council (mMRC) scale; (3) conducted the pulmonary ventilation and diffusion test, observing parameters:IC、FEV1、FEV1/FEV1pre、FVC、FEV1/FVC、TLC、RV、RV/TLC 、FRC; (4) part of subjects (81 case) were offered with the end-inspiratory high-resolution thoracic CT scan and calculated their emphysema index (%LAA-950), according to %LAA-950≥10% or not, the subjects were divided into Emphysema-predominant group(39) and Obstruction-predominant group(42); (5) given ICS+LABA(Budesonide/Formoterol 320/9.0ug, twice a day) combined inhaling treatment for 4 weeks, followed drug-use weekly; (6)repeated mMRC scores and pulmonary ventilation and diffusion test. Data was analyzed by SPSS 19.0 statistic software.Results:1. Basic information:56/180 case completed the whole study process.40 male,16 female, mean age (62.30±8.00), BMI (24.68±3.38) Kg/m2, FEV1 (1.34±0.48) L, FEV1/FEVlpre (51.27±17.53)%,FEV1/FVC (49.35±10.97)%, IC (2.02±0.59) L; TLC (4.97±0.75) L; RV (2.20±0.56) L; FRC (3.02±0.61)L; mMRC scores (1.94±0.90).2. Before treatment, the correlated analysis between IC, FEV1 and TLC, FRC, RV: IC showed great positive correlation with TLC (r=0.578, P<0.001);IC showed no obvious correlation with FRC and RV, r value was-0.103 and-0.116 seperately (P> 0.05); FEV1 also showed positive correlation with TLC (r=0.353, P<0.001); while negative correlation with RV (r=-0.246, P<0.05) and no obvious correlation with FRC(r=-0.124,P>0.05)3.Before treatment, IC showed obvious negative correlation with mMRC scores (r=-0.621, P<0.001); while FEV1 showed negative correlation with mMRC scores (r=-0.554, P<0.001),which is weaker than IC. In stepwise multiple regression analysis, the mMRC scoress was mostly significantly explained by IC(R2=34.4%).4. After treatment for 4 weeks, patients’mMRC scores decreased by (0.63±0.85) vs (1.94±0.90) (t=11.17, P<0.001); pulmonary function test parameters:IC increased by(2.44±0.67)vs(2.02±0.59) (t=-7.59, P<0.001); FEV1 increased by (1.56±0.56) vs (1.34±0.48) (t=-4.96, P<0.001); FRC dereased by (2.57±0.59) vs (3.02±0.61) (t=8.26, P<0.001); RV decreased by (1.63±0.62) vs (2.15±0.61) (t=3.68, P <0.01); TLC didn’t change obviously(t=-0.96, P>0.05).5.After treatment for 4 weeks, both △IC and AFEV1 showed no obvious correlation with mMRC scores(r=0.082,0.177, P> 0.05); while △IC showed negative correlation with △mMRC scores(r=-0.528, P<0.001), △FEV1 showed no obvious correlation with △mMRC scores(r=-0.201, P>0.05).6. After treatment, △IC showed obvious negative correlation with △FRC (r=-0.497, P<0.001); a negative correlation with △RV (r=-0.458, P<0.05); no obvious correlation with △TLC (r=0.199, P>0.05). △ FEV1 showed no obvious correlatin with △TLC, △FRC and △RV(r=-0.172,-0.236,-0.187 seperately, P>0.05).7. In Obstructive-predominant group, △FEV1 showed a negative correlation with △mMRC scores(r=-0.562, P<0.01), while in Emphysema-predominant group, △FEV1 showed no obvious correlation with △mMRC scores (r=-0.238, P>0.05); △IC showed a negative correlation with AmMRC scores both in Obstructive-predominant group and Emphysema-predominant group(r=-0.380,-0.405, P<0.05)Conclusion:1. Both IC and FEV1 can served as well predictors for dyspnea evalutaion in COPD patients;2. For emphysema-predominant phenotype COPD patients, the change of IC showed a better correlation with dyspnea improvement than FEV1...