Objective To study the relationship between the changes of short-term health-related life quality and the improvement/deterioration of forced expiratory volume in one second (FEV1) in patients with chronic obstructive pulmonary disease (COPD), and explore the feasibility of planning the frequency of pulmonary function test by evaluating the changes of life quality of COPD patients. Methods Based on the change of FEV1 (△FEV1), COPD patients from the standardized COPD and asthma management project database and its extended database of the center for chronic airway disease management, from 2020 to now, who completed pulmonary function tests and St. George's Respiratory Questionnaire (SGRQ) twice with an interval of 28 days, were divided into △FEV1 improvement group, △FEV1 deterioration group and △FEV1 maintenance group. The differences of SGRQ scores in different △FEV1 groups were analyzed, and the high-risk factors of △FEV1 deterioration group and the importance of influencing factors of △FEV1 deterioration were analyzed by neural network. Results A total of 1233 patients were included in the analysis. There were significant differences in △SGRQ total score, △SGRQ symptom, △SGRQ activity and △SGRQ impacts among △FEV1 groups (P<0.05). Compared with the △FEV1 maintenance group, the △FEV1 improvement group showed clinically significant improvement in both the total SGRQ score and each sub score, and the improvement value was more than 4 points. While the △FEV1 deterioration group showed statistically significant difference in the total SGRQ score and each sub score, but only showed clinically significant deterioration in the SGRQ symptom sub evaluation. Logistic regression model showed that the risk factors of △FEV1 deterioration included female (OR=2.11, 95%CI 1.23 - 3.59, P=0.006), baseline FEV1 (OR=2.63, 95%CI 1.92 - 3.60, P<0.001), △SGRQ (OR=1.02, 95%CI 1.01 - 1.03, P<0.001), baseline SGRQ symptom (OR=1.02, 95%CI 1.01 - 1.02, P<0.001) and △SGRQ symptom (OR=1.02, 95%CI 1.01 - 1.03, P<0.001), further neural network analysis showed that the importance orders of the five variables were △SGRQ total score (100.0%), △SGRQ symptom (86.9%), baseline FEV1 (71.4%), baseline SGRQ symptom (56.6%) and gender (29.6%). Conclusions The variables of short-term health-related life quality assessment of COPD patients are helpful to predict the changes of pulmonary function improvement, but the ability to predict the changes of pulmonary function deterioration is limited. For patients with no changes or improvement in short-term health-related life quality assessment, it is still recommended to increase the frequency of pulmonary function test in order to detect the deterioration of pulmonary function early.
Objective To evaluate the applicability of the cut-off points of different versions of the Asthma Control Questionnaire (ACQ) in the Chinese population and their consistency with the symptom control criteria of the Global Initiative for Asthma (GINA), so as to provide strategies for cut-off point selection in clinical practice. Methods Based on baseline data from a multicenter prospective cohort study, asthma patients who completed pulmonary function tests, GINA symptom control assessments, and the ACQ-7 questionnaire were included. Taking the GINA symptom control level as the gold standard, the Receiver Operating Characteristic Curve (ROC) was used to determine the optimal cut-off points of the ACQ for discriminating the GINA symptom control levels, and the consistency was analyzed by kappa statistics. Results Among 399 patients (58.9% female; mean age 44.5 ± 12.8 years), asthma symptom control, partial control, and uncontrolled rates were 61.7%, 27.6%, and 10.8%, respectively. ROC analysis revealed the following optimal cutoffs for identifying symptom control: ACQ-5 (0.5), ACQ-6Res (0.42), ACQ-6PFT (0.92), and ACQ-7 (0.93); for identifying uncontrolled symptoms: ACQ-5 (0.9), ACQ-6Res (1.08), ACQ-6PFT (1.42), and ACQ-7 (1.36). All corresponding areas under the ROC curve (AUC) exceeded 0.9. Consistency between ACQ and GINA symptom control levels was moderate (Fleiss’ κ = 0.453–0.531). Performance characteristics varied between traditional (0.75/1.5) and optimized cutoffs. After optimization, ACQ-5 emerged as the only version achieving balanced sensitivity-specificity (Youden index = 0.75) in dual tasks: ACQ-5 ≤ 0.5 demonstrated sensitivity (91%) and specificity (84%) for symptom control, while ACQ-5 ≥ 0.9 showed sensitivity (95%) and specificity (80%) for uncontrolled status. Conclusions Region-specific calibration of ACQ cutoffs enhances clinical utility in the Chinese population. A stratified application strategy is recommended: high-sensitivity cutoffs for initial screening to reduce underdiagnosis, high-specificity cutoffs for resource-constrained settings to minimize overtreatment, and optimized ACQ-5 cutoffs (≤0.5/≥0.9) for comprehensive management to balance sensitivity and specificity. Flexible combination of cutoff protocols tailored to screening objectives may optimize hierarchical asthma management.