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Pharmacological treatment response according to the severity of symptoms in patients with chronic obstructive
Jae Seung Lee1, Joon Beom Seo1, Sang Min Lee1
11 Department of Pulmonary and Critical Care Medicine and Clinical Research Center for Chronic Obstructive Airway Diseases, 2 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea ; 3 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Bundang CHA Hospital, College of Medicine, CHA University, Seongnam, South Korea ; 4 Division of Pulmonology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, South Korea ; 5 Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, South Korea ; 6 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea ; 7 Department of Internal Medicine, National Medical Center, Seoul, South Korea.
Background:
Pharmacological management of chronic obstructive pulmonary disease (COPD) is recommended according to the individualized assessment of symptoms and exacerbation risks. The aim of this study was to determine the relationship between the baseline Modified British Medical Research Council (mMRC) dyspnea scale and the COPD Assessment Test (CAT) score and pharmacological treatment response in patients with COPD.
Methods:
A total of 102 stable COPD patients who were enrolled in prospective cohort studies were analyzed. Pharmacological treatment responses after a 3-month treatment were assessed by changes on the mMRC dyspnea scale, CAT scores, and spirometric pulmonary functions.
Results:
Sixty-two patients with a mMRC dyspnea scale ≤1 were classified as having "less dyspnea" and 40 patients with a mMRC dyspnea scale ≥2 as having "more dyspnea". After a 3-month treatment, the mean mMRC dyspnea scale in the "more dyspnea" group was significantly decreased versus the "less dyspnea" group; however, there were no significant differences in CAT score changes or spirometric pulmonary function changes between the two groups. Baseline mMRC scales (Spearman's rho =-0.591, P<0.001) and baseline CAT scores (Pearson's r =-0.337, P=0.001) were significantly correlated with their changes after a 3-month treatment. Multiple logistic regression analysis demonstrated that baseline mMRC scale and CAT score were the only independent predictors of improvement greater than a minimal clinically significant difference after treatment.
Conclusions:
The severity of COPD symptoms is associated with their response to pharmacotherapy. COPD patients with a higher baseline mMRC dyspnea scale and CAT score experience greater symptom reduction by pharmacotherapy.
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