[Evaluation of clinical significance of chronic obstructive pulmonary disease assessment test].

OBJECTIVE: To determine the reliability and validity of the COPD assessment test (CAT) Chinese version in patients with chronic obstructive pulmonary disease (COPD), and to study its value in evaluating quality of life in Chinese patients. METHODS: One hundred and thirty-five patients with COPD in stable condition from Peking Union Medical College Hospital were assessed by interview with CAT Chinese version, and underwent pulmonary function test on the same day. The validity was documented by performing correlation analysis, and Pearson's correlation coefficients were calculated. The stages of COPD determined by CAT score and lung function were compared to observe the value of CAT in determining disease severity. RESULTS: Cronbach's alpha of CAT Chinese version was 0.805. CAT score increased with the severity of the disease, and was negatively correlated to FEV(1)% of predicted (r = -0.567, P < 0.01). CAT score varied significantly in patients (10 ± 5, 16 ± 6, 21 ± 7 and 23 ± 6), with different severity of COPD (χ(2) = 48.437, P < 0.01). There was a high degree of consistency between the stages of COPD determined by CAT score and lung function. CONCLUSIONS: The Chinese version of the CAT had good internal consistency reliability and validity, and can be used to assess the quality of life for Chinese COPD patients. It provided a simple, valid and standardized measurement of COPD health status.

[A new health-related quality of life questionnaires-chronic obstructive pulmonary disease assessment test].

Chronic obstructive pulmonary disease (COPD) is a major public health problem with high prevalence and mortality. A simple and effective tool for COPD assessment is urgently needed in clinical practice. The COPD Assessment Test is a newly developed questionnaire for assessing and monitoring COPD. This simple, highly sensitive, and highly reliable in assessing the patients quality of life and providing information concerning the severity of disease, and therefore can be widely applied.

[Costs of the last hospitalization for patients with acute exacerbation of chronic obstructive pulmonary disease and patients with lung cancer].

OBJECTIVE: To examine the cost for patients who died in hospital with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) compared with those died with lung cancer, and to examine their variations. METHODS: A retrospective cohort study was performed. The patients who died in hospital between January in 2003 and December in 2007 were enrolled. Statistical analysis was performed using the SPSS 13.0. RESULTS: Totally 416 patients were enrolled, with 86 COPD patients and 330 lung cancer patients. Patients with COPD were older than those with lung cancer. The incidences of co-morbidities such as coronary artery disease, hypertension, cerebrovascular disease, respiratory failure and lung infection in AECOPD patients were higher than those in lung cancer patients. Second malignant neoplasm of important organs was found in 211 patients (63.94%) with lung cancer. In the last hospitalization, the total amount of direct medical costs was higher for patients with AECOPD than for patients with lung cancer [74 143 (102 608) RMB vs 37 810 (51 374) RMB], z = 2.48, P < 0.05, especially for the treatment cost [(19 324 (61 843) vs 5876 (9764), z = 4.55, P < 0.01] and the laboratory cost [7976 (18 397) vs 3397 (4096), z = 5.97, P < 0.01]. There was no significant difference in the constituents of the cost between COPD and lung cancer patients (chi(2) = 8.23, P > 0.05). The percentage of the drug cost to the total cost was the highest, followed by the treatment cost and the auxiliary examination cost. The ratio of the drug cost to the total cost was lower in COPD patients (37.2 +/- 12.6)% vs (53.8 +/- 17.6)%, t = 7.34, P < 0.01, while the constituent ratio of treatment cost was higher in COPD than in lung cancer patients CONCLUSIONS: There was significant variability in healthcare resource utilization between COPD and lung cancer patients in their last hospitalization of life, the main reason of which was the increased costs of maintenance of life.

Economic analysis in admitted patients with acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: The socio-economic burden of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in Beijing is not fully understood. The study investigated the hospitalization cost in patients with AECOPD and the associated factors. METHODS: A multi-center, retrospective study was conducted in the four hospitals in Beijing including two level III hospitals and two level II hospitals. Patients with AECOPD admitted to the hospitals between January and December in 2006 were enrolled. The hospitalization cost and its relationship with disease severity and treatment were analyzed. RESULTS: Totally 439 patients were enrolled with 294 men (67.0%) and a mean age 73.4 years. The mean hospital stay was 20.7 days. A total of 204 patients (46.5%) had respiratory failure, 153 (34.9%) with cor pulmonale, 123 (28.0%) with coronary artery disease, 231 (52.6%) with hypertension, 70 (15.9%) with cerebrovascular disease and 32 (7.3%) with renal failure. The percentage of drug cost to total cost was the highest (71.2%), followed by laboratory cost (16.7%), therapy cost (9.7%), oxygen cost (7.3%), radiology cost (4.5%), examination cost (4.5%), bed cost (4.1%). Correlation analysis showed that cost was positively correlated with age, hospitalization days, co-morbidities such as respiratory failure and cor pulmonale, hypertension. Three hundred and twenty-one patients were further analyzed. The hospitalization cost increased in patients with non-invasive ventilation (P < 0.01), invasive mechanical ventilation (P < 0.01), ICU stay (P < 0.01), antibiotics (P < 0.05), systemic steroids (P < 0.01), and poor prognosis (P < 0.05). Correlation analysis showed that the hospitalization cost was negatively correlated with percentage forced expiratory volume in 1 second (FEV(1)%) (r = -0.149, P < 0.05), pH (r = -0.258, P < 0.01), and PaO(2) (r = -0.131, P < 0.05), positively correlated with PaCO2 (r = 0.319, P < 0.01), non-invasive positive pressure ventilation (r = 0.375, P < 0.01) and duration (r = 0.463, P < 0.01), invasive mechanical ventilation (r = 0.416, P < 0.01) and duration (r = 0.511, P < 0.01), ICU stay (r = 0.390, P < 0.01) and duration (r = 0.650, P < 0.01), antibiotics (r = 0.140, P < 0.05) and systemic steroids (r = 0.202, P < 0.01). CONCLUSIONS: AECOPD had a great impact on healthcare resources utilization. Disease severity, use of non-invasive or invasive ventilation, ICU stay and usage of antibiotics and systemic steroids were the major determinants of hospitalization cost. Long-term regular treatment aimed at reducing the frequency of acute exacerbation will lower the social and economic burden of chronic obstructive pulmonary disease (COPD).

[Assessment of health-related quality of life in cured SARS patients].

OBJECTIVE: To assess the quality of life in cured patients with severe acute respiratory syndrome (SARS). METHODS: One hundred and nineteen SARS outpatients, including 64 men and 55 women, with mean age (34.1 +/- 11.4) years and average days of discharge from hospital (28.0 +/- 12.8) days, were assessed by the St George's respiratory questionnaire (SGRQ), and 72 patients with spirometry test. RESULTS: The patients had a moderately degree physiological impairment and increased SGRQ score. Scores of all four part of SGRQ correlated significantly with diffuse capacity of the lung for carbon monoxide/pre (DLco%). The correlation coefficients between the activation, impaction, total score, and diffuse capacity of the lung for carbon monoxide/alveolar ventilation/pre (DLco/Va%) were resembled (r = 0.47-0.54, P < 0.01). There was a significant relationship between the score of SGRQ and patients age, and gender. The time leaving hospital only had a significant relationship with the symptom score of SGRQ. CONCLUSIONS: SGRQ is a sensitive tool for assessing quality of life in cured SARS patients. The cured SARS patients' quality of life decrease moderately.

[Assessment of pulmonary function in SARS patients during the convalescent period].

OBJECTIVE: To investigate the pulmonary function in severe acute respiratory syndrome (SARS) patients during the convalescent period. METHODS: Followup 89 outpatients of SARS. The follow-up study included interview, physical examination, and pulmonary function test. RESULTS: The interval between hospital discharge and functional assessment was 1.75 +/- 0.53 months (0.5-3.4 months). Mild to moderate abnormalities in pulmonary function were found in 48 patients (53.9%). Diffusion capacity for carbon monoxide (DLco) was impaired in 38 patients (42.7%); in 7 patients (7.9%), lung function was restrictive defect combined DLco impairment; Other patterns of impairment were revealed in 3 patient. Dyspnea during acute phase and CT during the convalescent period were found to have significant influences on DLco and total lung capacity (TLC). CONCLUSIONS: Diffusing capacity impairment as well as restrictive defect persist in convalescence SARS.