Kronik obstrüktif akciğer hastalarında KOAH değerlendirme testi (CAT)`nin solunumsal fonksiyon testleri, dispne ölçüm skalaları, ST . georges solunumsal anketi ile korelasyonu ve erken dönem hastaneye yatış riskini belirlemede kullanılabilirliği

Abstract

Bulgular: Çalışmaya 48 erkek (%92,3) ve 4 kadın (%7,7) olmak üzere 52 hasta alındı.Ortalama yaş 64 ± 9 (40-80) idi. Ortalama hastalık süresi 10,7 ± 7 (1-30) yıl iken ortalama sigara(46 hasta) paket/yıl 51,8 ±25 (15-150) idi. Hastaların 19‟u (%36,5) poliklinik hastasıyken 33‟ü(%63,5) serviste takip edilen hastalardan oluşmaktaydı. Hastaların 28 (%53,8) tanesi önceki 1 yıliçinde hastanede yatış öyküsüne sahipken 24‟ünde (%46,2) önceki 1 yılda yatış öyküsü yoktu.Ortalama CAT puanı 24,9 ±9,7 ve ortalama CAT doldurma süresi 3,15 dk. idi. Hastaların CATskoru incelendiğinde yatan hastaların skoru ayaktan hastalara kıyasla istatistiksel olarak anlamlıyüksekti (29,73± 8,37 karşı 17,21±6,80 ve p<0,01). Önceki 1 yıl içerisinde hastanede yatan hastaların ortalama CAT skoru28,75 ± 10,05 iken önceki 1 yıl içerisinde hastanede yatmamış hastaların ortalama CAT skoru21,61 ± 10,05 (p<0,01) idi.Aynı şekilde sonraki 3 ay içerisinde hastanede yatma endikasyonuolmayan hastaların ortalama CAT skoru 22,89 ± 9,8 iken sonraki 3 aylık dönemde hasta yatışıolan hastaların ortalama CAT değeri 29,87 ± 7,82 idi (p=0,018).Hastaların ortalama CATpuanı ile diğer dispne ölçütleri kıyaslaması yapıldığında mMRC evre 4 ile evre 5 arasındaistatistiksel anlamlı fark izlendi. SGRQ toplam skorunda 60 puan altı ile 60 ve üzeri puan alanlararasında istatistiksel anlamlı fark gözlendi. Aynı şekilde Borg sınıf 1 (Borg1,2,3,4 puanlarındanbirini alan grup) ve Borg sınıf 2 (5,6,7 puanlarından birinin alan grup) arasında ve Borg sınıf 2ile Borg sınıf 3 (Borg 8,9,10 puanlarından birini alan grup) arasında istatistiksel anlamlı farkizlendi. CAT puanı, SGRQ bölüm ve toplam puanları ve Borg ile mMRC ölçeği arasında pozitifistatistiksel anlamlı korelasyon saptandı. (p<0,01)Sonuç: CAT testi KOAH‟ ın her döneminde hastalığın karakteristik ve karmaşık yapısınıgösterebilen kolay, kısa, anlaşılır ve günlük pratikte hasta hekim arasında ki iletişimi sağlayarakhastaların daha optimum şekilde ele alınmasını sağlayacak, daha önce kullanılan çeşitlidispne ölçüm testleri ile mükemmel uyumlu bir testtir. Bu testin günümüzde de akciğerfonksiyon testlerine yardımcı olarak tüm KOAH hastalarında kullanılmasını tavsiye etmekteyiz.Anahtar sözcük: CAT testi, KOAH, Dispne Ölçüm Skalaları

Aim:Classically pulmonary function tests are used to diagnose, determine the severity and evaluatetreatment response in COPD patients. In many clinical studies a decision is made by assessment ofvariation in FEV1 value. However, COPD is an airway flow restriction that is not responded orpartially responded to bronchodilators, so to evaluate the course of the disease the life quality andsymptoms of the patients should also be taken into consideration. In this study, we aimed to comparethe newly defined, targeting to measure the life quality of patient, COPD assessment test (CAT)with other tests defined before for the same purpose and which are long lasting in daily practice; andto show the availability of CAT in prediction of early hospital admission of COPD patients.Materials and method:COPD patients presented to outpatient and inpatient clinic ofNecmettinErbakan University Meram Medical Faculty Pulmonary Medicine Department wereenrolled to the study. Age, file numbers, phone numbers, disease period, COPD stage, smokingand environmental biomass exposure history, COPD exacerbation and hospitalization history inthe past 1 year period and 3 months period after the test (with the phone calls and hospital records)and co-morbidities of the patients were recorded. In our clinic pulmonary function test laboratory,pre-bronchodilator and post-bronchodilator pulmonary function tests were done. In asepticconditions, arterial blood gas analysis from radial artery and synchronous digital oxygen saturationby pulse oximetry were recorded. However, cases using systemic steroid were not included to study.After these test, in a silent room face to face m MRC, SGRQ and CAT were done with achronometry, by the method clinician asking the questions and marking the answers. The patientswere asked to mark the Borg scale after a 10 to 15 minutes of exercise. SGRQ score was measuredin computer.viiResults:Forty eight male(92,3%) and 4 female (7,7%), totally 52 patients were enrolled to thestudy. Mean age was 64 ± 9 (40-80). While mean disease time was 10,7 ± 7 (1-30) years, meansmoking period was (46 patients) 51,8 ±25 (15-150) pack-years. Nineteen (36,5%) of patientswas from outpatient clinic and 33 (63,5%) of them were comprised of patients followed ininpatient clinic. While, 28 (53,8%) of patients had a history of hospitalization in the past 1 year,24 (46,2%) of them did not have hospitalization history. Mean CAT score was 24,9 ±9,7 andmean CAT fill time was 3,15 min.When we evaluate the CAT score of the patients; the score ofinpatient cases were statistically significantly higher that cases compared to outpatient clinic(29,73± 8,37 versus 17,21± 6,80 and p<0,01). The mean CAT score of cases hospitalized in thelast 1 year was 28,75 ± 10,05 and mean CAT score of cases that were not hospitalized was21,61 ± 10,05 (p<0,01) . Similarly mean CAT score of cases that were not admitted to hospitalin the 3 months period after the test was 22,89 ± 9,8 and the CAT score of cases hospitalized inthis period was 29,87±,82 (p=0,018).When we compared the mean CAT scores of the patients and otherdyspnea scales, significant difference was found with mMRC stage 4 and stage 5. In SGRQ totalscore significant difference was observed between cases took a score under 60 and a scoreabove60. Similarly, statistical significant was present between Borg class 1 (group that took the scoreof one of Borg 1,2,3 or 4) and Borg class 2 ( group that took the score of one of Borg 5,6 or 7);and between Borg class 2 and Borg class 3 (group that took the score of one of Borg 8,9 or 10).Positive statistically significant correlation was found between CAT score, SGRQ division andtotal scores and with Borg and mMRCscale (p<0,01).Conclusion: CAT is a easy, short, understandable test that can show the characteristic andcomplex structure of COPD in every stage of the disease and a test that will provide optimumevaluation of cases by providing the communication between the clinician and patient in dailypractice; and it is excellently compatible with different dyspnea measurement test used before.We advise to use this test in all COPD patients as a helpful test beside pulmonary function testsin daily practice.Key words: CAT test, COPD, DyspneaMeasurementScales