Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea

Abstract

Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.

Common and distinct risk factors that influence more severe and distressing shortness of breath profiles in oncology outpatients

“…One plausible explanation is that multimorbidity may increase severity and distress ratings by increasing overall symptom burden 69 and emotional distress 70 and decreasing functional status 71 and quality of life. 72 This hypothesis is consistent with our current findings across the three LPAs, that patients with the worse profiles reported lower KPS scores, higher levels of depressive symptoms and anxiety, and higher levels of other common symptoms.…”

Prevalence of anxiety and depression symptoms and their associated factors in non-cystic fibrosis bronchiectasis patients from China: a cross-sectional study

“…As it can cause signi cant clinical symptoms (such as cough, phlegm, or hemoptysis), result in poor quality of life, and increased economic burden and mortality rates, it has become an important public health problem [8,9]. Studies have reported that psychological comorbidities are more common in patients with chronic airway disease than the general population [10]. Bronchiectasis, as a kind of chronic airway diseases, also commonly coexists with psychological comorbidities, such as anxiety and depression [11,12].…”

The Clinical Application of Established and Emerging Biomarkers for Chronic Respiratory Diseases

“…Among these, the 6-min walking distance (6MWD) has been found to be a valuable tool for evaluating the functional status and mortality risk of CRD patients due to its ease of use, cost-effectiveness, and high potential for standardization [6]. Similarly, the modified Medical Research Council (mMRC) questionnaire and the COPD assessment test (CAT) have been effectively used in clinical guidelines and, consequently, in clinical practice for staging disease severity and predicting health status deterioration, exacerbations, and mortality, not only in COPD but also in other clinical settings [15]. Combining many of the aforementioned clinical and functional measures, the BODE index has progressively emerged as a composite clinical marker, with high prognostic value compared to other standard geriatric tools [16].…”