Multidisciplinary, non-pharmacological breathlessness intervention service for patients with moderately severe to severe COPD: a randomised controlled trial.

Breathlessness intervention services (BIS), which coach patients to self-manage breathlessness using non-pharmacological strategies, are effective in a variety of populations, including those with cancer and serious respiratory disease.

呼吸困难干预服务（BIS）通过指导患者使用非药物策略自我管理呼吸困难，在包括癌症和严重呼吸系统疾病在内的多种人群中被证明是有效的。

This study aimed to compare the impact of the Westmead Breathlessness Service in people with moderate to severe COPD.

本研究旨在比较Westmead呼吸困难服务对中重度慢性阻塞性肺疾病（COPD）患者的影响。

Methods

We analysed 113 participants randomised (1:1) with moderate/severe COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 ≤60% predicted) and disabling breathlessness (modified Medical Research Council (mMRC) Breathlessness Score ≥2) to either an 8-week intervention involving breathing techniques, handheld fan use, exercise, energy conservation, dietetic advice (n=54) or 8-week wait-list control group (n=59).

我们分析了113名随机分配（1:1）的参与者，这些参与者患有中重度慢性阻塞性肺疾病（COPD）（第一秒用力呼气容积（FEV1）/用力肺活量（FVC）<0.70且FEV1≤60%预计值）和有活动受限的呼吸困难（改良版医学研究委员会（mMRC）呼吸困难评分≥2），他们被随机分配到接受为期8周的干预措施（包括呼吸技巧、手持风扇使用、运动、节能和饮食建议，n=54）或8周等待名单对照组（n=59）。

The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) Mastery of breathlessness subscale.

主要结果是慢性呼吸问卷（CRQ）呼吸困难掌握子量表的变化。

Secondary outcomes included change in other CRQ subscales (Fatigue, Emotion and Dyspnoea), exertional breathlessness intensity/unpleasantness (0-10 Numerical Rating Scale Score), anxiety and depression.

次要结果包括其他CRQ子量表（疲劳、情绪和呼吸困难）的变化，运动性呼吸困难强度/不愉快感（0-10数字评分量表得分），以及焦虑和抑郁。

Difference in change over 8 weeks between groups was compared using ANCOVA; p<0.05 statistically significant.

使用ANCOVA比较了8周内两组变化的差异；p<0.05表示具有统计学意义。

Results

Participants were aged 70.9 (±8.5) years, 50% female, mean FEV1 =0.8 L (±0.3 L; 34% predicted), mMRC Breathlessness Score 3 (IQR 3-4).

参与者平均年龄为70.9（±8.5）岁，女性占50%，平均第一秒用力呼气容积（FEV1）为0.8升（±0.3升；预计值为34%），mMRC呼吸困难评分为3（四分位数间距为3-4）。

CRQ-Mastery improved following intervention compared with control (between-group difference 0.5 units; 95% CI 0.2 to 0.8; p=0.0262) using modified intention-to-treatanalysis.

干预组的CRQ掌握度较对照组有所提高（组间差异0.5单位；95% 置信区间0.2至0.8；p=0.0262），使用了修改后的意向治疗分析。

Better CRQ-Dyspnoea and CRQ-Fatigue were seen in the intervention group (between-group difference-CRQ-Dyspnoea 0.4 units; CI 0.1 to 0.7; p=0.005, and CRQ-Fatigue 0.4 units; CI 0.1 to 0.7; p=0.014).

干预组显示出更好的CRQ呼吸困难和CRQ疲劳改善（CRQ呼吸困难组间差异0.4单位；置信区间0.1至0.7；p=0.005，以及CRQ疲劳0.4单位；置信区间0.1至0.7；p=0.014）。

Exertional breathlessness intensity (difference -0.8 units; CI -1.4 to -0.2; p=0.013) and breathlessness unpleasantness (difference -1.2 units; CI -1.7 to -0.6; p=0.001) also improved.

用力呼吸困难强度（差异-0.8单位；95%置信区间-1.4至-0.2；p=0.013）和呼吸困难不愉快感（差异-1.2单位；95%置信区间-1.7至-0.6；p=0.001）也有所改善。

interpretation

An 8-week BIS improved CRQ-Mastery, Dyspnoea and Fatigue, exertional breathlessness intensity and unpleasantness in people with severe COPD.

8周的BIS改善了严重COPD患者的CRQ-Mastery、呼吸困难和疲劳、用力呼吸困难强度和不愉快感。