Health Status Deterioration in Patients with Chronic Obstructive Pulmonary Disease

Abstract

An accelerated decline of FEV 1 is well-documented in patients with chronic obstructive pulmonary disease (COPD). Although FEV 1 is a useful measure for diagnosis and prognosis, it is neither a good predictor of the symptomatic response to treatment in COPD (1) nor of the likelihood of hospitalization (2). This has led to the use of generic and disease-specific questionnaires to measure the impact of COPD on health status. Crosssectional studies have shown that patient populations with a lower FEV 1 have worse health-related quality of life (3). However, to our knowledge there are no data concerning the rate of change in health status within patients over time.We hypothesized that decline in health status would be detectable in a population of patients in whom COPD was the principal pathology and that this would be amenable to treatment. All components of the disease-specific St George's Respiratory Questionnaire (SGRQ) have shown sensitivity to impaired health in COPD (4). The physical function components of the generic Short-Form 36 (SF-36) have demonstrated sensitivity to change in COPD and to treatment with fluticasone in severe asthma (5, 6) so we expected these components of the SGRQ and SF-36 to show the greatest sensitivity to change in our study. Because it is known that smoking has an effect on rate of decline in FEV 1 , we also hypothesized that smoking status would influence health status and its rate of deterioration. We used data collected as part of the Inhaled Steroids in Obstructive Lung Disease (ISOLDE) study of fluticasone in COPD. The intention-to-treat analyses of the principal outcomes of this trial are reported elsewhere (7). For this analysis, health status was measured using a generic instrument, the SF-36 and a disease-specific instrument, the SGRQ. METHODS PatientsFull details of the study methodology, patient selection, and spirometric procedures are presented elsewhere (7). Seven hundred fifty-one patients (560 men) with a diagnosis of COPD consistent with American Thoracic Society (ATS) recommendations (8) were recruited from 18 centers throughout the United Kingdom. All were current or exsmokers age 40 to 75 yr with a postbronchodilator FEV 1 of at least 0.8 L, but less than 85% predicted. The FEV 1 /FVC ratio was less than 70%. Exclusion criteria were: an FEV 1 response to 400 g salbutamol of Ͼ 10% predicted; use of ␤ -adrenergic blockers; use of nontrial inhaled corticosteroids or regular oral corticosteroid; a life expectancy of less than 5 yr from non-COPD diseases. At baseline values, postbronchodilator FEV 1 expressed as percent of predicted normal was 50 Ϯ 15 (SD)%. The mean FEV 1 response to salbutamol was 4.4% predicted (0.13 L). During the study, patients requiring long-term treatment with oral corticosteroids or more than two short courses of treatment in any 3-mo period were withdrawn. Ethical committee approval was obtained in each participating center and informed consent was obtained before entry to the study.

Influência das características sociodemográficas e clínicas e do nível de dependência na qualidade de vida de pacientes com DPOC em oxigenoterapia domiciliar prolongada

“…In a study conducted in England and involving COPD patients, FEV 1 was found to correlate with the physical functioning, role-physical, social functioning, and general health domains, whose r values ranged from 0.15 to 0.25 (p < 0.001 for all). (25) In two other studies, FEV 1 was found to correlate with the SF-36 physical component summary (r = 0.38; p = 0.012), (10) as well as with a visual analog scale that rates health status (r = 0.19; p < 0.05). (26) Anemia, in addition to being a predictor of mortality in COPD patients on LTOT, can contribute to increasing dyspnea and cause exercise limitation.…”

Changes in personal control as a predictor of quality of life after pulmonary rehabilitation

“…The COPD patients in this study were in advanced stages of their illnesses and therefore, the possibilities for improvement with respect to physical aspects of QoL were probably limited [31]. Previous research has shown that during the course of their illness, COPD patients gradually decline with respect to pulmonary function and with respect to physical and other domains of QoL [37,50]. This process of deterioration can only be retarded, with medication for instance, but not stopped [36].…”

A new perspective on optimal care for patients with COPD

“…5,6,[15][16][17][18] Recent studies suggest that exacerbation risk is related to previous exacerbation history, physical activity levels, presence of particular comorbidities such as gastro-oesophageal reflux, and disease severity. 19 Current therapies are known to decrease the frequency of these future exacerbation events.…”