Lebensqualität bei Patienten mit häuslicher Beatmung

Zusammenfassung

Die gesundheitsbezogene Lebensqualität wird als mehrdimensionales psychologisches Konstrukt definiert, welches das subjektive Befinden eines Patienten auf physischer, psychischer, sozialer und funktionaler Ebene beschreibt. Die Evaluation der gesundheitsbezogenen Lebensqualität hat zunehmend an Bedeutung in der Bewertung medizinischer Therapiestrategien bei der Behandlung chronischer und nicht heilbarer Erkrankungen gewonnen und ist insbesondere auch bei Patienten mit häuslicher Beatmung und schweren objektiven Einschränkungen im Alltag von entschiedener Bedeutung. Moderne Instrumente, wie der Severe Respiratory Insufficiency (SRI) Questionnaire, sind speziell für diese Patientengruppe entwickelt worden und eignen sich zur Beurteilung des Therapieeffektes einer häuslichen Beatmung auf die gesundheitsbezogene Lebensqualität im Rahmen wissenschaftlicher Studien. Arbeiten der letzten Jahre haben gezeigt, dass die psychische Befindlichkeit bei stabiler Krankheitssituation nach Einleitung einer häuslichen Beatmung trotz erheblicher körperlicher Beeinträchtigungen normal sein kann und dass die gesundheitsbezogene Lebensqualität entscheidend von der Grunderkrankung abhängig ist. Dabei gilt der positive Effekt der häuslichen Beatmung auf die gesundheitsbezogene Lebensqualität bei Patienten mit thorakal-restriktiven und den meisten neuromuskulären Erkrankungen als bewiesen. Widersprüchlich sind jedoch die Daten zur gesundheitsbezogenen Lebensqualität bei COPD. Hier sind prospektive kontrollierte Studien mit Anwendung der modernen spezifischen Messinstrumente in der Zukunft nötig, um den Effekt der häuslichen Beatmung auf die gesundheitsbezogene Lebensqualität bei der COPD zuverlässig zu untersuchen.

Abstract

Health-related quality of life (HRQL) is defined as a psychological construct describing the subjectively experienced health status based on different components of health including physical state, psychological well-being, social relations and functional capacities. Assessment of HRQL has become steadily more essential in order to evaluate the costs and benefits of modern treatment modalities in patients with chronic and incurable diseases. This is particularly true for patients with home mechanical ventilation (HMV) and severe objective limitations in daily living. Modern instruments such as the Severe Respiratory Insufficiency (SRI) Questionnaire have been specifically designed for clinical trials which aim at assessing the effects of HMV on HRQL in these patients. Recent work has shown that mental health in clinically stable patients following establishment of HMV can be normal despite substantial physical handicaps. Further, HRQL has been shown to be predominantly influenced by the underlying disease. Accordingly, there is increasing evidence that HMV provides beneficial effects on HRQL in patients with neuromuscular and thoracic rib cage diseases, but in contrast, this remains still controversial in patients with COPD. Here, prospective controlled trials using modern specific instruments for HRQL assessment are required in the future to reliably evaluate the effects of HMV on HRQL in patients with COPD.

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