Magnus Ekström, Hayley Lewthwaite, Pei Zhi Li, Jean Bourbeau, Wan C Tan, Dennis Jensen
{"title":"识别慢性阻塞性肺病患者的异常用力呼吸困难：比较 mMRC 和 CAT 与 CPET。","authors":"Magnus Ekström, Hayley Lewthwaite, Pei Zhi Li, Jean Bourbeau, Wan C Tan, Dennis Jensen","doi":"10.1016/j.chest.2024.10.027","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale and/or COPD Assessment Test (CAT).</p><p><strong>Research question: </strong>What is the ability of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD?</p><p><strong>Study design and methods: </strong>Analysis of people aged ≥40 years with post-bronchodilator FEV<sub>1</sub>/FVC<0.70 and ≥10 smoking pack-years from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg 0-10) intensity rating > upper limit of normal (ULN) at the symptom-limited peak of CPET using normative reference equations.</p><p><strong>Results: </strong>We included 318 people with COPD (40% women), age 66.5±9.3 years (mean±SD), FEV<sub>1</sub> 79.5±19.0%predicted; 26% had abnormally low exercise capacity (V'O<sub>2peak</sub> <lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC=0 and CAT<10, respectively. A mMRC≥2 and CAT≥10 was most specific (95%) to detect abnormal exertional breathlessness, but had low sensitivity of only 12%. Accuracy for all scale cut-offs or combinations was <65%. Compared with 'true negatives', people with abnormal exertional breathlessness but low mMRC and/or CAT scores ('false negatives') had worse self-reported and physiological outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to have any respiratory medication (37% versus 30%; mean difference 6.1%; 95% confidence interval -7.2 to 19.4; p=0.36).</p><p><strong>Interpretation: </strong>In COPD, mMRC and CAT have low concordance with CPET and fail to identify many people with abnormally high exertional breathlessness.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":""},"PeriodicalIF":9.5000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Identifying abnormal exertional breathlessness in COPD: comparing mMRC and CAT with CPET.\",\"authors\":\"Magnus Ekström, Hayley Lewthwaite, Pei Zhi Li, Jean Bourbeau, Wan C Tan, Dennis Jensen\",\"doi\":\"10.1016/j.chest.2024.10.027\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Chronic obstructive pulmonary disease (COPD) management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale and/or COPD Assessment Test (CAT).</p><p><strong>Research question: </strong>What is the ability of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD?</p><p><strong>Study design and methods: </strong>Analysis of people aged ≥40 years with post-bronchodilator FEV<sub>1</sub>/FVC<0.70 and ≥10 smoking pack-years from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg 0-10) intensity rating > upper limit of normal (ULN) at the symptom-limited peak of CPET using normative reference equations.</p><p><strong>Results: </strong>We included 318 people with COPD (40% women), age 66.5±9.3 years (mean±SD), FEV<sub>1</sub> 79.5±19.0%predicted; 26% had abnormally low exercise capacity (V'O<sub>2peak</sub> <lower limit of normal). Abnormally high exertional breathlessness was present in 24%, including 9% and 11% of people with mMRC=0 and CAT<10, respectively. A mMRC≥2 and CAT≥10 was most specific (95%) to detect abnormal exertional breathlessness, but had low sensitivity of only 12%. Accuracy for all scale cut-offs or combinations was <65%. Compared with 'true negatives', people with abnormal exertional breathlessness but low mMRC and/or CAT scores ('false negatives') had worse self-reported and physiological outcomes during CPET, were more likely to have physician-diagnosed COPD, but were not more likely to have any respiratory medication (37% versus 30%; mean difference 6.1%; 95% confidence interval -7.2 to 19.4; p=0.36).</p><p><strong>Interpretation: </strong>In COPD, mMRC and CAT have low concordance with CPET and fail to identify many people with abnormally high exertional breathlessness.</p>\",\"PeriodicalId\":9782,\"journal\":{\"name\":\"Chest\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chest\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.chest.2024.10.027\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.10.027","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Identifying abnormal exertional breathlessness in COPD: comparing mMRC and CAT with CPET.
Background: Chronic obstructive pulmonary disease (COPD) management is guided by the respiratory symptom burden, assessed using the modified Medical Research Council (mMRC) scale and/or COPD Assessment Test (CAT).
Research question: What is the ability of mMRC and CAT to detect abnormally high exertional breathlessness on incremental cardiopulmonary cycle exercise testing (CPET) in people with COPD?
Study design and methods: Analysis of people aged ≥40 years with post-bronchodilator FEV1/FVC<0.70 and ≥10 smoking pack-years from the Canadian Cohort Obstructive Lung Disease study. Abnormal exertional breathlessness was defined as a breathlessness (Borg 0-10) intensity rating > upper limit of normal (ULN) at the symptom-limited peak of CPET using normative reference equations.
Results: We included 318 people with COPD (40% women), age 66.5±9.3 years (mean±SD), FEV1 79.5±19.0%predicted; 26% had abnormally low exercise capacity (V'O2peak
Interpretation: In COPD, mMRC and CAT have low concordance with CPET and fail to identify many people with abnormally high exertional breathlessness.
期刊介绍：
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
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