Factors influencing decline in quality of life in smokers without airflow obstruction: The COPDGene study

Abstract

Current and former smokers with normal spirometry and with Preserved Ratio Impaired Spirometry (PRISm) experience respiratory events similar to chronic obstructive pulmonary disease (COPD) exacerbations. Exacerbations significantly reduce quality of life (QoL) in COPD patients however the effect of respiratory exacerbations on QoL in these groups is unknown. We hypothesized that exacerbations and change in exacerbation status would predict QoL decline among normal spirometry and PRISm participants in COPDGene. Methods: COPDGene is a multicenter, longitudinal study in the U.S. designed to identify genetic determinants of COPD. We enrolled study subjects in Phase 1 of COPDGene and performed multivariable logistic regression models to determine independent predictors of decline in quality of life [>4 points on the St George's Respiratory Questionnaire (SGRQ)]. Separate analyses were performed for current and former smokers with normal spirometry and PRISm. Frequent exacerbator status was defined by > 2 moderate or >1 severe exacerbations in the year prior to the baseline and year 5 follow-up visits. Results: Independent predictors of QoL deterioration included current smoking, higher exacerbation frequency, and a change from infrequent to frequent exacerbation status (REF: infrequent to infrequent exacerbation status) in both groups [PRISm (OR ¼ 3.15,95%CI, 1.67-5.94), normal spirometry (OR ¼ 4.72,95%CI, 3.25-6.86)]. A change from frequent to infrequent exacerbation status did not lower the odds of QoL decline in either cohort. Conclusion: Continued smoking and the onset of frequent exacerbations were predictors of QoL decline in smokers with normal spirometry and PRISm. Further studies are needed to identify modifiable factors associated with decline in QoL in smokers.

Prevalence and Characteristics of Individuals with Preserved Ratio Impaired Spirometry (PRISm) and/or Impaired Lung Function in Japan: The OCEAN Study

“… 20 , 34 In the current study, we found that current smokers had the highest prevalence of airflow limitation and PRISm, and it is known that continued smoking and the onset of frequent exacerbations are predictors of declining quality of life in smokers with PRISm. 35 These findings support the screening of individuals 40 years of age or older who are current or former smokers to facilitate early diagnosis of COPD and identify those at risk of developing COPD or at increased risk of COPD-related mortality. 36 Specifically, such individuals should undergo spirometry testing for COPD diagnosis and should be offered smoking cessation, dietary, and exercise interventions.…”

Chronic obstructive pulmonary disease patients' quality of life and its related factors: A cross-sectional study of the Jordanian population

“…These are all indicators of the main factors that may affect the perception of QoL for these patients in Jordan, probably internationally as well. 5,11,14,15,18,33,39 Therefore, these constitute reasonable goals for the healthcare service providers and planners to target to improve the QoL perceptions among patients with COPD.…”

“…8 The correlation between COPD symptom load and anxiety and depression is important, as the combination of these disorders can worsen the disease course, duration, and outcome. 9 Studies have shown that COPD negatively correlates with the Quality of Life (QoL), [10][11][12][13][14][15][16][17] and this correlation worsens as the severity increases. Kushwaha et al (2020) reported "impaired" life processes and health-related quality of life among patients with COPD.…”

Physical performance in relation to preserved ratio impaired spirometry: a cross-sectional study of community-dwelling older Japanese adults

“…Risk factors include age, female sex, a history of smoking, diabetes mellitus, and obesity 5,7,15,16 . Moreover, increased dyspnoea, reduced 6-min walk distance 1 , and reduced health-related quality of life 17,18 have been reported in individuals with PRISm.The Genetic Epidemiology of COPD (COPDGene) study and other reports discussing PRISm 1-3,8,18 have explained the condition using medical data 4,6,9 . However, few studies have focused on community-dwelling individuals 7 .…”

“…Risk factors include age, female sex, a history of smoking, diabetes mellitus, and obesity 5,7,15,16 . Moreover, increased dyspnoea, reduced 6-min walk distance 1 , and reduced health-related quality of life 17,18 have been reported in individuals with PRISm.…”