Limited studies have identified symptom clusters (SCs) and their risk factors and the relationships with inflammatory biomarkers in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).
In this study, we aimed to investigate SCs in patients with AECOPD and explore their influencing factors and relationships with inflammatory biomarkers.
Data were collected with sociodemographic and disease information questionnaires, and symptoms were measured with the revised Memorial Symptom Assessment Scale. SCs were extracted through exploratory factor analysis. Logistic regression analysis was conducted to explore the risk factors of SCs.
A total of 151 patients were recruited. Two SCs, namely, emotional and respiratory functional SCs, were identified. Logistic regression analysis showed that individuals with high C-reactive protein level, Charlson Comorbidity Index score, and high modified Medical Research Council Dyspnea Scale score were more likely to belong to the high-severity symptom subgroup than to the low-severity symptom group in the emotional SC. The patients with a low body mass index and without or lax inhaled drug therapy exhibited highly prominent predictors of membership in the high-severity symptom group of the respiratory functional SC.
Symptoms experienced by patients with AECOPD were grouped into specific clusters. Targeted interventions should be performed based on SCs, and influencing factors and biological mechanisms should be considered when providing individualized approaches and interventions.
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- Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019.Eur Respir J. 2019; 53 (1900164)
- Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): a national cross-sectional study.Lancet. 2018; 391: 1706-1717
- Epidemiology of chronic obstructive pulmonary disease: prevalence, morbidity, mortality, and risk factors.Semin Respir Crit Care Med. 2015; 36: 457-469
- Impact and prevention of severe exacerbations of COPD: a review of the evidence.Int J Chron Obstruct Pulmon Dis. 2017; 12: 2891-2908
- Subgroup analysis of symptoms and their effect on functioning, exercise capacity, and physical activity in patients with severe chronic obstructive pulmonary disease.Heart Lung. 2013; 42: 465-472
- Chronic obstructive pulmonary disease among adults—United States, 2011.MMWR Morb Mortal Wkly Rep. 2012; 61: 938-943
- Identification of anxiety symptom clusters in patients with COPD: implications for assessment and treatment.Int J Behav Med. 2015; 22: 590-596
- Symptoms and functional performance in Korean immigrants with asthma or chronic obstructive pulmonary disease.Heart Lung. 2012; 41: 226-237
- Symptom burden in stable COPD patients with moderate or severe airflow limitation.Heart Lung. 2014; 43: 351-357
- Symptom clusters: concept analysis and clinical implications for cancer nursing.Cancer Nurs. 2005; 28: 270-282
- Symptom clusters and quality of life in subjects with COPD.Respir Care. 2017; 62: 1203-1211
- Symptom distress, cluster, and management in Thais with COPD.Pac Rim Int Nurs Res. 2014; 18: 244-262
- Similarity and stability of symptom cluster in severity and distress among persons with chronic obstructive pulmonary disease.Pac Rim Int Nurs Res. 2015; 19: 89-106
- Symptom clusters and health-related quality of life in Chinese patients with chronic obstructive pulmonary disease.West J Nurs Res. 2019; (193945919866475)
- Symptom clusters in chronic obstructive pulmonary disease: a systematic review.Appl Nurs Res. 2019; 45: 23-29
- Symptom assessment of patients with chronic obstructive pulmonary disease.West J Nurs Res. 2007; 29: 845-863
- Inflammatory biomarkers and depression.Neurotox Res. 2011; 19: 308-318
- Systemic inflammatory markers in COPD: results from the Bergen COPD Cohort Study.Eur Respir J. 2010; 35: 540-548
- Biomarkers of systemic inflammation and depression and fatigue in moderate clinically stable COPD.Respir Res. 2011; 12: 3
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Evaluation of clinical methods for rating dyspnea.Chest. 1988; 93: 580-586
- Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease.Thorax. 1999; 54: 581-586
- The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress.Eur J Cancer. 1994; 30A: 1326-1336
- Measuring the symptom experience of Chinese cancer patients: a validation of Chinese version of the memorial symptom assessment scale.J Pain Symptom Manage. 2009; 37: 44-57
- Multivariate methods to identify cancer-related symptom clusters.Res Nurs Health. 2009; 32: 345-360
- The common factor model and exploratory factor analysis.2nd ed. The Guilford Press, London2015
- Experiences of older people following an acute exacerbation of chronic obstructive pulmonary disease: a phenomenological study.J Clin Nurs. 2018; 27: e1110-e1119
- Factors related to depressed mood in adults with chronic obstructive pulmonary disease after hospitalization.Home Healthc Nurse. 2008; 26: 474-482
- Breathlessness, anxiety, depression, and function—the BAD-F study: a cross-sectional and population prevalence study in adults.J Pain Symptom Manage. 2020; 59: 197-205
- Structural brain changes in patients with COPD.Chest. 2016; 149: 426-434
- Brain activation during perception and anticipation of dyspnea in chronic obstructive pulmonary disease.Front Physiol. 2017; 8: 617
- Family context influences psychological outcomes of depressive symptoms and emotional quality of life in patients with heart failure.J Cardiovasc Nurs. 2014; 29: 517-527
- From inflammation to sickness and depression: when the immune system subjugates the brain.Nat Rev Neurosci. 2008; 9: 46-56
- Two risk factors for depression in chronic obstructive pulmonary disease.Med Sci Monit. 2018; 24: 1417-1423
- Symptom profiles and inflammatory markers in moderate to severe COPD.BMC Pulm Med. 2016; 16: 173
- Comparison of World Health Organization and Asia-Pacific body mass index classifications in COPD patients.Int J Chron Obstruct Pulmon Dis. 2017; 12: 2465-2475
- Prevalence of COPD in Copenhagen.Respir Med. 2011; 105: 410-417
- BMI is associated with FEV1 decline in chronic obstructive pulmonary disease: a meta-analysis of clinical trials.Respir Res. 2019; 20: 236
- The relationship of dyspnea and disease severity with anthropometric indicators of malnutrition among patients with chronic obstructive pulmonary disease.Pak J Med Sci. 2018; 34: 1408-1411
- Triple therapy with budesonide/glycopyrrolate/formoterol fumarate with co-suspension delivery technology versus dual therapies in chronic obstructive pulmonary disease (KRONOS): a double-blind, parallel-group, multicentre, phase 3 randomised controlled trial.Lancet Respir Med. 2018; 6: 747-758
- Low-dose budesonide/formoterol counteracts airway inflammation and improves lung function in chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2019; 199: 662-664
- It's bad-really bad-but does it matter? Medication adherence in chronic obstructive pulmonary disease.Am J Respir Crit Care Med. 2017; 195: 1282-1283
- Consensus in identification and stability of symptom clusters using different symptom dimensions in newly diagnosed acute myeloid leukemia patients undergoing induction therapy.J Pain Symptom Manage. 2019; 57: 783-792
Published online: April 07, 2020
Accepted: March 27, 2020
© 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.