Evaluation of Symptomatology of COPD-Patients in Practice

german translation / full article

Thomas Hausen

Keywords: COPD lung function mMRC symptoms therapy

Background: Unlike in asthma, COPD therapy is not adjusted to the results of quantitative measurements, but to symptoms and the number of exacerbations. For assessment of symptoms, experts recommend the use of the COPD Assessment Test (CAT) or Clinical COPD Questionnaire, or alternatively the modified Medical Research Council scale, which captures only dyspnoea-related functional impairment. The last method can be used easily and quickly. The objective of this study was to assess the use of the last one scale and FEV1 in daily practice.Methods: In 2017, 1914 clinical practices in Germany collected patient data regarding age, gender, mMRC score, post-bronchodilator FEV1, reason for enconter , and medication use (morning medication yes/no). A maximum of 15 patients per practice were included. Results: Data from 26,300 patients, of whom 52 % were male, 2 % missing were collected. The primary reasons for visiting the practice were a repeat prescription (57 %) or treatment of symptoms (49 %). Both reasons could be present simultaneously. Of the 78 % of patients who took morning medication, 45 % presented for symptoms and 62 % for follow-up prescription. Of the patients who did not take morning medication (20 %), 61 % presented for symptoms and 39 % for a repeat prescription. 2 % had no data regarding morning medication. Patients who did not take morning medication were younger, had less severe airflow limitation, and were more likely to visit for symptoms than older patients who took their morning medication and who had more severe airflow limitation. The proportion of affected patients decreased with severity of breathlessness measured by mMRC. Most patients had moderate airway limitation (24 % mild, 23 % severe, and 5 % very severe airflow limitation). The mMRC correlated well with post-bronchodilator FEV1 (Spearman correlation coefficient = 0.58996).Conclusions: As long as we have no quantitative means of assessing response to treatment, preference should be given to the easiest method (and therefore more likely to be used regularly) in clinical practice. A clear correlation was observed between the mMRC score and FEV1, confirming that the mMRC scale provides reliable results and can be used quickly in daily clinical practice.

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