Poor Physical Capacity in Bronchiectasis Patients Is Correlated with Poor Quality of Life

Abstract

Background: Bronchiectasis (BE) is an increasing burden on healthcare systems, and there is an urgent need for improved treatments, better clinical care and for clinical and translational research on this condition. Reducing the number of exacerbations is one of the key goals in BE management. Patients who suffer from frequent exacerbations are likely to experience more exacerbations, which have negative effects on quality of life (QoL), healthcare utilisation and mortality. Thus, we aimed to investigate the risk factors associated with quality of life (QoL) in a cohort of Finnish non-cystic fibrosis BE patients.Methods: A cross-sectional study is part of the EMBARC. Recruitment occurred between August 2016 and March 2018 from three clinics in Helsinki University Central Hospital, Finland. The study included 95 adult patients (mean age was 69 (SD± 13) years). Seventy nine percent were women. A disease-specific quality of life-bronchiectasis (QoL-B) questionnaire was applied, and scores in the lowest quarter (24%) indicate poor QoL. The bronchiectasis severity index (BSI) and FACED score were used. The severity of dyspnoea was examined using the modified Medical Research Council (mMRC) dyspnoea scale. Results: Almost all (82%) presented with chronic sputum production and exacerbation, with a median rate of 1.7 (SD ±1.6). Exacerbations (OR 1.7), frequent exacerbations (OR 4.9, p < 0.01), high BSI score (OR 1.3, p < 0.01) and extensive disease (OR 3.7, p = 0.05) were predictive of poor QoL. Frequent exacerbations were associated with bronchial bacterial colonisation, low forced expiratory volume in one second (FEV1) and radiological disease severity. Based on the BSI, 34.1% of our cohort had severe disease, whereas 11.6% were classified as severe according to the FACED score. The mMRC dyspnoea score (r = -0.57) and BSI (r = -0.60) were negatively correlated with physical domain in QoL-B questionnaire. Conclusion: Frequent exacerbations, radiological disease severity and high BSI score were predictive of poor QoL. Reduced physical capacity was correlated with dyspnoea and severity of disease. Interventions to reduce bacterial colonisation and to maintain physical functioning should be used to minimize exacerbations and to improve QoL.Study registration: University of Helsinki, faculty of medicine; 148/16.08.2017; Registered 16 August 2017; https://researchportal.helsinki.fi/