The Clinical Application Of Different Evaluation System In Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease(COPD), a common preventable and treatable disease, is characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. COPD primarily affects the lungs, and also can cause some significant extra pulmonary effects. Exacerbations and comorbidities contribute to the overall severity in individual patients. Lung function is an important objective criterion to diagnosis and assesses the severity of COPD, but it can not fully reflect the clinical characteristics and risk estimates of the disease. Suggestion by GOLD update 2013 about complete assessment of COPD includes symptoms, degree of airflow limitation(using spirometry), risk of exacerbations and comorbidities. The goals of COPD assessment are to determine the severity of the disease, its impact on patient’s health status, and the risk of future events(exacerbations, hospital admissions, death) in order to guide therapy.There are several methods worldwide used as measurement of COPD:St George’s Respiratory Questionnaire(SGRQ); COPD assessment test(CAT); modified British medical research council(m MRC); clinical COPD questionnaire(CCQ); 6-minute walk test(6MWT); BODE, et al. Each scale has its own advantages and disadvantages. For example, SGRQ has a good correlation with lung function and symptoms, and the sensitivity of the evaluation of patients with COPD condition changes is also very high, but clauses and sub clauses in SGRQ are too complex,requiring complicated statistics and consuming too much time,it is hard to finish by poorly educated patient. m MRC only assess breathing difficulty. CAT is not good for making a diagnosis and giving treatment to COPD patients with complications,it is either helpless for evaluating complications and making decisions about diagnosis and treatment. CCQ is poor than other questionnaire in its reliability and validity. And 6MWT need patient’s certain exercise capacity. Since each scale has its own merits and demerits and application restrictions,it is necessary to find out the relationships among them and discuss their value in clinical application. This study aims to analyze the CAT, m MRC, CCQ, SGRQ, 6MWD,and FEV1%pred in the evaluation of COPD severity, and establish the relationships among them,as well as to investigate into a simple, effective, practical and low-cost system to evaluate COPD severity.Objective: To evaluate the health status, dyspnea and exercise endurance in the patients with chronic obstructive pulmonary disease(COPD) by the CAT scale, m MRC dyspnea scale, CCQ,SGRQ, 6MWT, and to analyze the correlation among their evaluation results with forced expiratory volume in one second percentage of predicted value percentage(FEV1% pred)and discuss their value in clinical application.Methods: 90 patients with COPD were performed the examinations of the lung function,CAT scale,m MRC score, CCQ, SGRQ and 6MWT.The correlation among the various evaluation systems and between each evaluation system with the severity of the pulmonary function airway limitation were comprehensively evaluated; and COPD patients according to comorbidites, gender, age grouping, to observe the differences. All data analyzed with SPSS 19.0, P<0.05 was shown for outcome.Results: 1.FEV1%pred and CAT scores was negatively correlated(r=-0.338,P=0.01);FEV1%pred and m MRC score was negatively correlated(r=-0.703, P<0.01); FEV1%pred and CCQ was negatively correlated(r=-0.529, P<0.01); FEV1%pred and SGRQ was negatively correlated(r=-0.852, P<0.01);FEV1%pred and PEF was positively correlated(r=0.879, P<0.05).2.There was a strong correction between the four respiratory questionnaire(CAT, m MRC, CCQ and SGRQ),P<0.01.3. 6MWD and CAT scores was significantly negatively correlated(r=-0.521, P<0.01);6MWD and m MRC score was significantly negatively correlated(r=-0.671, P<0.01);6MWD and CCQ scores was significantly negatively correlated(r=-0.566, P<0.01);6MWD and SGRQ score was significantly negatively correlated(r=-0.590, P<0.01).4.BODE and FEV1%pred was negatively correlated(r=-0.837, P<0.01);BODE and CAT scores was positively correlated(r=0.493, P<0.01);BODE and m MRC score was positively correlated(r=0.804, P<0.01);BODE and CCQ was positively correlated(r=0.638, P<0.01); BODE and SGRQwas positively correlated(r=0.837, P<0.01); BODE and annual exacerbation was positively correlated(r=0.880, P<0.01).5.Using CAT, CCQ and m MRC to make a comprehensive evaluation, the results for high-risk patients of three methods of assessment are consistent, and there are significant differences between the two evaluation methods(CAT, m MRC) for low-risk patients results(P < 0.05), and CAT, CCQ evaluation results are consistent.Conclusions: 1.The four respiratory questionnaire(CAT, m MRC, CCQ and SGRQ) were correlated with FEV1%pred, could be truly and effectively reflect the quality of life of patients with COPD.And quality of life respiratory questionnaire can be used as an effective complement to lung function, and be used for COPD the patient’s daily condition monitoring.2. There was a strong correction between the four respiratory questionnaire(CAT, m MRC, CCQ and SGRQ). m MRC was suitably in evaluating the activity in patients with dyspnea, CAT and CCQ had a more comprehensive evaluation in the assessment of the impact of patients’ daily life and health of body and mind.3. 6MWD is related with m MRC score; CAT scores, CCQ, SGRQ and FEV1%pred, it can well reflect the ability level of COPD patients who complete daily physical activity function with compensatory, and it can be used as an objective tool to evaluate the extra pulmonary effects of disease in COPD patients.4. BODE is significantly correlated with m MRC score, CAT scores, CCQ and SGRQ, and can evaluate the influence of COPD patients comprehensively and accurately.5.Whenm MRC is applied to evaluation of the symptoms of COPD patients may cause symptoms undervaluation and even cause the difference of the COPD group, so we prefer to use CAT or CCQ scores.