The Influence of an Inhaled Steroid on Quality of Life in Patients With Asthma or COPD

Schayck, C.P. van; Dompeling, E.C.; Rutten, M.P.M.H.; Folgering, H.T.M.; Boom, G. van den; Weel, Chris van

doi:10.1378/chest.107.5.1199

Cited by 61 publications

(25 citation statements)

References 42 publications

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“…Previous studies have measured change in health status by comparing baseline to endpoint values (1, 12) but few have assessed change using more than two measurement points. Other trials have measured health status on multiple occasions but have design limitations such as small sample size (18), sole use of a generic measure (19), or use of a relatively untested generic measure on a male-only population (5). This is the first published study to document health status decline prospectively in a large and well-characterized population.…”

Section: Discussionmentioning

confidence: 99%

Health Status Deterioration in Patients with Chronic Obstructive Pulmonary Disease

Spencer

Calverley²,

Burge³

et al. 2001

Am J Respir Crit Care Med

307

197

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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.

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Section: Discussionmentioning

confidence: 99%

Health Status Deterioration in Patients with Chronic Obstructive Pulmonary Disease

Spencer

Calverley²,

Burge³

et al. 2001

Am J Respir Crit Care Med

307

197

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“…Only two studies assessing the responsiveness of the NHP in COPD patients have been published [2, 3]. Randomised clinical trials have failed to show that bronchodilators and inhaled corticosteroids were effective in improving perceived distress over a 1- or 2-year period.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies using generic HRQoL measures such as the Nottingham Health Profile (NHP) [2, 3], the Quality of Well-Being Scale [4], the Sickness Impact Profile [4, 5]and the Medical Outcomes Study 20-item short-form survey [6]have failed to show any changes in the HRQoL associated with treatment for COPD. This failure to detect any changes may be due to the lack of sensitivity of the generic instruments.…”

Section: Introductionmentioning

confidence: 99%

Change in Generic and Disease-Specific Health-Related Quality of Life during a One-Year Period in Patients with Newly Detected Chronic Obstructive Pulmonary Disease

Tsukino

Nishimura²,

McKenna³

et al. 2002

Respiration

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Background: Although the health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD) has been assessed by generic or disease-specific HRQoL measures, the responsiveness of the generic HRQoL measures is generally weak. Objectives: To investigate the responses generated by generic and disease-specific HRQoL questionnaires, we prospectively followed the clinical course of patients with newly detected COPD after the initiation of treatment. Methods: A prospective, longitudinal study with a 1-year follow-up was designed. The forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), the Nottingham Health Profile (NHP) as a generic HRQoL measure, and the Chronic Respiratory Disease Questionnaire (CRQ) as a disease-specific HRQoL measure were measured at baseline and at 3, 6, and 12 months after the initiation of standard treatment. Results: Eighty-two patients completed the study. The FEV₁, FVC, and NHP and CRQ scores improved significantly during the first 3 months (p < 0.05). During the last 6 months, although the FEV₁ declined (p < 0.05), the HRQoL assessed by the NHP and CRQ remained elevated. Except for the score on the social isolation section of the NHP at 12 months, all HRQoL scores at 6 and 12 months were significantly improved compared to baseline (p < 0.05). Conclusion: In new patients with COPD, the NHP as well as the CRQ was able to detect changes in the HRQoL associated with effective medical interventions. The influence of the changes in airflow limitation on the HRQoL was weak.

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“…The second section contains seven items that address areas of daily living affected by a patient9s health status [64]. This instrument has been demonstrated to be valid and reliable among patients with COPD [28,65] and has been administered among patients with COPD in trials of LVRS [31], inhaled corticosteroids [66], bronchodilator [67] and pulmonary rehabilitation [68]. Very little data exist regarding how much difference represents an MID.…”

Section: Generic Versus Disease-specific Instrumentsmentioning

confidence: 99%

The assessment of health status among patients with COPD

Curtis¹,

Patrick²

2003

Eur Respir J

116

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Survival and physiological measures alone do not represent the full experiences of patients with chronic obstructive pulmonary disease. Reducing the personal and social burden of disease by improving patients9 symptoms, functional status and quality of life are also important goals.There has been a substantial increase in the use of newly developed tools that measure health status and it is important for clinicians and researchers to understand these instruments9 strengths and weaknesses in providing insight into a patient9s condition and experience.Relying only on mortality and physiological outcomes could blind a clinician to significant benefits patients may receive from a treatment. A growing body of research utilises end-points assessed directly by patients whose self-reported health status includes health-related quality of life and functional status.This article reviews major concepts and methods in health-status assessments for patients with chronic obstructive pulmonary disease, which will have an important role in assessing the efficacy and effectiveness of new treatments. Eur Respir J 2003; 21: Suppl. 41, 36s-45s.

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The Influence of an Inhaled Steroid on Quality of Life in Patients With Asthma or COPD

Cited by 61 publications

References 42 publications

Health Status Deterioration in Patients with Chronic Obstructive Pulmonary Disease

Health Status Deterioration in Patients with Chronic Obstructive Pulmonary Disease

Change in Generic and Disease-Specific Health-Related Quality of Life during a One-Year Period in Patients with Newly Detected Chronic Obstructive Pulmonary Disease

The assessment of health status among patients with COPD

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