Health-related quality of life and risk factors associated with spirometric restriction

Abstract

The restrictive spirometric pattern is associated with a substantial morbidity and mortality burden. We sought to determine to what extent spirometric restriction is associated with impaired quality of life.We used data from two large population-based European cohorts: 6698 European Community Respiratory Health Survey (ECRHS) and 6069 Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults (SAPALDIA) adult participants. The restrictive pattern was defined as forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC) ≥lower limit of normal (LLN) and FVC <LLN; an obstructive pattern was defined as FEV/FVC <LLN independent of FVC. The Physical Component Summary and Mental Component Summary of quality of life were computed using the Short Form-36 questionnaire.In both cohorts, the restrictive pattern was associated with heavy smoking, being underweight or obese and the coexistence of respiratory symptoms. In univariate analyses, compared with the normal group, both the restrictive and obstructive pattern had significant Physical Component Summary deficits (-2.77 and -2.08, respectively, in ECRHS; -3.25 and -2.14, respectively, in SAPALDIA; all p-values <0.001). However, in models adjusted for sex, age, education, body mass index, smoking, comorbidities and respiratory symptoms, only the restrictive pattern remained significantly associated with Physical Component Summary deficits (p=0.004 in ECRHS; p=0.001 in SAPALDIA).The restrictive spirometric pattern is associated with deficits in the physical component of quality of life that are partly independent of the presence of respiratory symptoms.

Restrictive spirometry pattern is associated with low physical activity levels. A population based international study

“…physical activity, such as exercise performance and the physical component of quality of life, are reduced in subjects with a restrictive spirometry pattern [9,14], which supports the plausibility of our results.…”

“…Second, interventions encouraging physical activity in individuals with a restrictive spirometry pattern should be designed and tested. Having a restrictive spirometry pattern is associated with poor quality of life and functional limitation [9,10], therefore it is plausible that increasing one's physical activity could improve quality of life and stabilise decreases in lung capacity. Finally, our results suggest that physical inactivity may be behind the previously observed poor prognosis of restrictive spirometry pattern.…”

“…In SAP-ALDIA, measurements reproducible within 5% and with less than 100 ml difference were included. We derived the percent value predicted for FVC and the Lower-Limit of Normal (LLN) for the FEV 1 /FVC ratio using study-specific equations [9,22]. A restrictive spirometry pattern was defined as having a post-bronchodilator FEV 1 /FVC ≥ LLN and a FVC < 80% predicted [7].…”

“…Impaired quality of life [9], important functional limitations [10] and a higher risk of suffering cardiovascular events [11][12][13] have all been associated with restrictive spirometry pattern. Furthermore, an association between restrictive spirometry pattern and mortality has been consistently found across studies in different settings and using different definitions [1][2][3]14,15].…”

Looking at the COPD spectrum through “PRISm”

“…In a recent study in a large Danish cohort, ÇOLAK et al [14] found that even when FEV 1 /FVC >0.8, the presence of chronic respiratory symptoms is associated with respiratory-related hospitalisation and death. Remarkably, PRISm patients with such restrictive spirometric pattern seem to have a lower quality of life even when they are asymptomatic [15].…”