Gender-associated differences in dyspnoea and health-related quality of life in patients with chronic obstructive pulmonary disease

BACKGROUND AND OBJECTIVES: Recent studies have reported several gender-associated differences among patients with COPD, but gender-associated differences in health-related quality of life (HRQoL) in patients with COPD have not yet been clarified. This study evaluated gender differences in dyspnoea and HRQoL in patients with COPD. METHODS: Study participants were 156 patients with COPD (men 117, women 39); men were individually matched to women by age and FEV(1)% predicted to give a ratio of 3:1 (male : female). Study participants were evaluated for dyspnoea and completed HRQoL questionnaires. An oxygen cost diagram (OCD) was used to assess the degree of dyspnoea and Morale Scale was used to assess subjective well-being. St. George's Respiratory Questionnaire (SGRQ) and SF-36 were used for HRQoL evaluation. The findings in the male and female groups were compared. RESULTS: The OCD and Morale Scale showed significantly lower values for female patients with COPD. Disease-specific HRQoL assessed by SGRQ was significantly worse, except for symptoms, in female patients with COPD. Generic HRQoL assessed by SF-36 was also significantly worse, except for general health and social functioning. Stepwise multiple regression showed OCD, Morale Scale and 6-min walking distance to be significantly associated with total SGRQ score in the male group, and Morale Scale and 6-min walking distance were significant associations in the female group. CONCLUSIONS: Gender differences exist in dyspnoea and HRQoL in patients with COPD. These need to be considered when designing treatment strategies for COPD patients.     

Pain and quality of life with chronic obstructive pulmonary disease

Background

Pain as a symptom may be underrecognized in patients with chronic obstructive pulmonary disease (COPD).

Objective

The aim of this study is to explore the prevalence and intensity of pain, its location, how demographic and clinical variables may be related to pain, and how pain is associated with quality of life (QOL).

Methods

In this cross-sectional study, 154 patients with COPD answered the Brief Pain Inventory, Respiratory Quality of Life Questionnaire, and Quality of Life Scale, and performed spirometry.

Results

Seventy-two percent of the patients indicated the location of pain on a body diagram. Lower lung function, higher score of pain intensity, and pain interference were associated with lower disease QOL. A higher score of pain interference was associated with lower global QOL. When controlling for disease QOL in the equation of global QOL, pain interference was no longer significant.

Conclusion

The experience of pain is related to disease QOL in patients with COPD.     

Usefulness of a linear analog scale questionnaire to measure health-related quality of life in elderly patients with chronic obstructive pulmonary disease

OBJECTIVES: To examine the validity, discriminatory ability, and responsiveness of health-related quality-of-life (HRQoL) questionnaires using a linear analog scale (Quality of Life (QOL) scale) for chronic obstructive pulmonary disease (COPD). DESIGN: Cross-sectional and longitudinal. SETTING: Outpatient. PARTICIPANTS: One hundred two elderly subjects with mild to severe COPD. MEASUREMENTS: Scores on the QOL scale, the St. George's Respiratory Questionnaire (SGRQ), and the 36-item Short-Form Health Survey questionnaire (SF-36) and various clinical parameters were recorded. The correlations between these QOL questionnaires and various clinical parameters were then examined. The responses of 31 elderly COPD patients to the QOL scale and the SGRQ before and 3 months after the completion of a comprehensive pulmonary rehabilitation program were compared longitudinally. RESULTS: On cross-sectional study, the QOL scale showed a significant correlation with the total score and three components of the SGRQ. The QOL scale correlated significantly with all components of the SF-36, but the total SGRQ score correlated with only six components of the SF-36, excluding vitality and the mental health index. Both the QOL scale and the total score of the SGRQ correlated significantly with the oxygen cost diagram (OCD), Morale scale, 6-minute walking distance (6MWD), forced expiratory volume in 1 second, and instrumental activities of daily living (IADL) score. When subjects were divided into three groups according to disease severity (mild, moderate, severe) using American Thoracic Society guidelines, the total SGRQ score discriminated between the three groups. The QOL scale could not discriminate between mild and moderate or moderate and severe. On longitudinal study, 3 months after finishing the comprehensive pulmonary rehabilitation program, the QOL scale, the SGRQ, 6MWD, and OCD all showed significant improvement. The difference in the QOL scale after the comprehensive pulmonary rehabilitation program showed a significant correlation with changes in the SGRQ total score and the OCD but not with the 6MWD. CONCLUSION: The QOL scale is similar to more-complex questionnaires such as the SGRQ in terms of validity and responsiveness for evaluating disease-specific HRQoL in elderly COPD patients. In clinical settings, the QOL scale, as a simple questionnaire, may be useful for disease-specific HRQoL assessments in elderly COPD patients.     

Impact of chronic obstructive pulmonary disease on respiratory status and quality of life in newly diagnosed patients with lung cancer

OBJECTIVE AND BACKGROUND: A significant proportion of patients with lung cancer have associated COPD, which is considered an independent risk factor and cause of morbidity and mortality. However, the effect of COPD on respiratory status and quality of life in lung cancer has not been evaluated. METHODS: Newly diagnosed patients with lung cancer were assessed at diagnosis before starting treatment, for detailed respiratory status, spirometry and World Health Organization-Bref Quality of Life questionnaire in Hindi (WHOQOL-Bref Hindi). RESULTS: One hundred and sixty patients were studied. Spirometry was abnormal in 92.7% patients, 42% had COPD, and the majority (88.6%) had advanced disease (stage III and IV). Patients scored poorly in all QOL domains, with social domain faring worst. Karnofsky Performance status (KPS) correlated significantly with all QOL domains. No significant differences were found in clinical profile, KPS, or QOL scores between patients with and without COPD. Chest pain and dyspnoea severity (assessed by Medical Research Council) grading and visual analogue scale correlated with physical QOL domain. CONCLUSION: Patients with lung cancer have a poor QOL that is affected by the severity of respiratory profile and KPS. The presence of COPD does not significantly affect QOL in lung cancer patients.     

Clinically important changes in health-related quality of life for patients with chronic obstructive pulmonary disease

OBJECTIVE: Without clinical input on what constitutes a significant change, health-related quality of life (HRQoL) measures are less likely to be adopted by clinicians for use in daily practice. Although standards can be determined empirically by within-person change studies based on patient self-reports, these anchor-based methods incorporate only the patients' perspectives of important HRQoL change, and do not reflect an informed clinical evaluation. The objective of this study was to establish clinically important difference standards from the physician's perspective for use of 2 HRQoL measures among patients with chronic obstructive pulmonary disease (COPD). DESIGN: We assembled a 9-person expert panel of North American physicians familiar with the use of the Chronic Respiratory Questionnaire (CRQ), a disease-specific HRQoL measure, or the generic Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36, Version 2.0) among patients with COPD. RESULTS: Using 2 rounds of the Delphi process, 1 in-person meeting, and an iterative improvement process for circulating and correcting the final report, the expert panel established small, moderate, and large clinically important change levels for the CRQ and SF-36. CONCLUSIONS: For this expert physician panel, levels for detecting clinically important differences on the CRQ were equal to or slightly higher than previous studies based on patient-reported differences. Clinically important differences on the SF-36, Version 2.0, were noticeably larger than previous estimates based on cross-sectional differences between clinically defined patient groups.     

Emphysema on imaging is associated with quality of life in elderly patients with chronic obstructive pulmonary disease

Background:   Limited data are available on the association between the severity of emphysema or airway narrowing, and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD), which has been seen to be more prevalent among elderly subjects. The aim of this study was to examine the association between HRQOL, physical parameters and structural alterations in lung of COPD patients.
Methods:   Stable COPD patients ( n  = 125; mean age 71.0) were studied. Both the severity of emphysema, which was expressed as the extent of the low-attenuation area (LAA%), and percentage of the large airway wall area (WA%) on high-resolution computed tomography (HRCT) were compared with various parameters of the generic and HRQOL, respectively, together with pulmonary function tests and exercise capacity.
Results:   The predicted value of forced expiratory volume in 1 s was significantly associated with both LAA% and WA%, but the diffusion capacity was strongly correlated with LAA% alone. Parameters of the generic and HRQOL, and almost all other parameters appeared to be significantly associated with LAA% alone, whereas no association was observed between WA% and QOL.
Conclusion:   We concluded that the severity of emphysema, but not that of large airway narrowing on HRCT, is associated with both generic and health-related QOL and reduced diffusion capacity. This notion might provide useful information in practice among elderly subjects who are unable to perform a spirometry.     

慢性阻塞性肺疾病患者生命质量及其相关因素研究进展

随着医学模式从单纯的生物-医学模式向生物-心理-社会模式的转变,目前对"健康"的理解已不局限于寿命的延长,提高生命质量更为重要.本文综述了慢性阻塞性肺疾病患者生命质量概念、生命质量测量表及其选择以及生命质量的影响因素.     

Outpatient pulmonary rehabilitation in patients with chronic obstructive pulmonary disease

Objective

To evaluate an entirely outpatient-based program of pulmonary rehabilitation in patients with chronic obstructive pulmonary disease COPD, using St.George’s Respiratory questionnaire (SGRQ), the 6-minutes walking test (6-MWT) and BODE index as the primary outcome measures.

Methods

A prospective, parallel-group controlled study of an outpatient rehabilitation program in 80 patients with COPD (67 men and 13 women; mean age 64.8 ± 10.6 years; FEV₁, 42.8% ± 7.6% of the predicted value. The active group (n = 40) took part in a 14-week rehabilitation program [3 h/wk, 1.5 h of education and exercise and 1.5 h of cycling]. The control group (n = 40) was reviewed routinely as medical outpatients. The following evaluations were carried out at study entry and after14 weeks: (1) pulmonary function studies; (2) 6-minutes walking test 6MWT; (3) quality of life; and (4) BODE index.

Results

The following patients completed the study: 35 patients (87.5%) from the active group (mean age, 63.7 ± 11.9 years; mean forced expiratory volume in one second (FEV₁), 41.9 ± 2.6% of the predicted value); and 36 patients (88%) from the control group (mean age, 65.9 ± 10.3 years; mean FEV₁, 43.33 ± 3.6% of the predicted value). We found no changes in pulmonary function parameters in the active group and the control one at 14weeks. On the other hand, there were significant changes within the components of the SGRQ (12.3 for the score total) for the patients of the active group but not for the patients of the control one (only 1.5 for the score total), we observed also a significant increase in the distance of the 6-MWT in the patients of the active group but not for the patients of the control one, and finally a decrease of two points (from 6 to 4) was noted in the score of the active group’s BODE index without any change in the control group’s one.

Conclusion

An outpatient-based of 14-week rehabilitation program significantly improved the quality of life and exercise tolerance without any change in the pulmonary function in patients with moderate COPD, and there was also a large decrease in the risk of death in rehabilitated patients as measured using the BODE index.     

慢性阻塞性肺疾病患者生活质量评估方法的研究进展

健康相关生活质量量表对于慢性阻塞性肺疾病患者生活质量的评估起着非常重要的作用.迄今为止,相关学者已相继研发了许多种量表.COPD评估测试不仅简便短小,而且拥有与以往复杂问卷相似的评估能力,值得在全球推广.     

抗抑郁治疗对慢性阻塞性肺疾病患者生活质量及预后的影响

目的观察抗抑郁治疗COPD合并抑郁患者生活质量及预后的影响。方法 COPD合并抑郁患者50例,分为治疗组和对照组。对照组给予COPD标准治疗,治疗组予COPD标准治疗联合抗抑郁治疗。对比两组治疗前后肺功能、圣乔治呼吸疾病问卷(SGRQ)评分、呼吸困难问卷(mMRC)分级;随访COPD急性加重再住院例次。结果两组治疗后肺功能均有改善(P<0.05),但组间差异无统计学意义;两组治疗后SGRQ评分、mMRC分级均有改善(P<0.05),治疗组差异更显著;再住院例次治疗组低于对照组(P<0.05)。结论抗抑郁治疗能改善COPD合并抑郁患者呼吸困难症状,进而改善患者生活质量及预后。     

慢性阻塞性肺疾病患者生命质量及其相关因素分析

目的 对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者生命质量及其相关因素进行分析.方法 选择山西医科大学第一医院呼吸内科门诊及住院稳定期慢性阻塞性肺疾病患者126例.选用由蔡映云教授等设计的慢性阻塞性肺疾病生命质量测量表对患者进行评估.据COPD患者人口学特征、流行病学特征和临床诊治经验对可能影响患者生命质量并有可能进行干预的11项因素进行调查和分析,包括年龄、职业、营养状况、受教育程度、经济状况、吸烟量、呼吸困难程度、急性加重频率、体育锻炼、共患疾病、第1秒用力呼气容积占预计值的百分比和动脉血氧分压.结果 纳入COPD患者126例,所填问卷均完整、准确,全部进入结果 分析.①动脉血氧分压对生命质量总分及日常生活能力有影响,其标准回归系数β分别为-0.192、和-0.205,t分别为-3.202和-2.791,P值均＜0.01.②呼吸困难程度对生命质量总分和日常生活能力、焦虑心理症状和抑郁心理症状3个因子均有影响,标准回归系数β分别为0.204、0.265、0.264和0.366,t分别为2.841、3.487、2.982和4.582,P值均＜0.01.③肺功能对日常生活能力和社会活动状况两个因子有影响,其标准回归系数β分别为0.173和0.205,t分别为2.013和2.503,P值均＜0.01.结论 影响COPD患者生命质量的主要因素有年龄、体质量指数、体育锻炼、共患疾病、急性加重次数、呼吸困难程度、肺功能和动脉血氧分压.根据标准回归系数的大小可以看出,各因子对生命质量总分的影响从大到小依次为体育锻炼、急性加重次数、呼吸困难程度、动脉血氧分压、共患疾病、体质量指数和年龄.     

Clustering effects of chronic obstructive pulmonary disease specific quality of life in hospitalized patients

OBJECTIVES: The primary aim of treatments for COPD is to improve health-related quality of life. However, little is known of the clustering effects related to health-related quality of life as an outcome measure. If clustering effects are observed, these have important implications for sample size estimates when cluster randomization is used in interventional studies. This study aimed to determine the intracluster correlation coefficient (ICC) of the quality of life, between hospitals for COPD patients. METHODOLOGY: The Dyspnoea Impact and Symptoms Questionnaire was administered to 100 COPD inpatients from four public hospitals (25 from each) around metropolitan Melbourne, selected on the basis that they had not had any major programs implemented within the last 2 years that aimed to improve the management of COPD. Data were collected concerning demographic and socioeconomic variables and comorbidities. RESULTS: The highest ICC value for a health-related quality of life subscale was 0.02 (psychological score), while the highest for a symptom-based subscale was 0.04. CONCLUSIONS: There is minimal clustering effect of quality of life in COPD patients between the hospitals studied. Despite this, when using a cluster randomised design the sample size needed to detect the same effect as a study using simple randomisation could be inflated by up to 183%. If cluster randomization is required, the average cluster size should be kept as small as possible to negate this effect.     

中国七省市慢性阻塞性肺疾病患者的生命质量现况调查

目的 评估COPD患者的牛命质量及其影响因素.方法 2002-2004年对北京、上海、广东、辽宁、天津、重庆和陕西等7个地区城乡40岁及以上人群进行COPD横断面调查,对入选的20245人进行问卷调查和肺功能检测,采用12个条目的 简短生命质量量表(SF-12)评估生命质量,支气管舒张试验后FEV1/FVC＜70%者诊断为COPD.SF-12评分经秩转换后采用一般线性模型分析比较各组间的差别.采用多因素逐步线性同归分析方法 分析影响生命质量的因素.结果 与非COPD患者相比,COPD患者的生命质量下降,心理成分评分分别为(56±7)分和(57±6)分,躯体成分评分分别为(46±9)分和(50±6)分,差异均有统计学意义(F值分别为4.442和453.960,P＜0.05和P＜0.01).COPD患者的心理成分评分主要受气促严重程度、体重指数、合并疾病、性别和居住在城乡的影响;COPD患者的躯体成分评分主要受气促严重程度、合并疾病、性别、COPD分级、职业粉尘烟雾暴露史、年龄、文化程度和既往诊断COPD的影响.结论 COPD患者的生命质量下降,并与气促和疾病严重程度、体重指数和合并疾病密切相关.改善气促症状,加强营养支持,减少合并疾病,远离危险因素的暴露可以改善COPD患者的生命质量.     

慢性阻塞性肺疾病评估测试对生存质量的评估价值研究

目的探讨慢性阻塞性肺疾病(COPD)评估测试(CAT)用于我国COPD患者生存质量的应用价值。方法选择2010年4月至2011年2月中国医科大学附属第一医院呼吸内科就诊和定期随访的COPD患者107例,其中男57例,女50例,年龄40～86岁,平均(67.4±9.8)岁。分别对患者进行中文版CAT和圣.乔治呼吸问卷(SGRQ)调查,同时进行肺功能测定。验证CAT的信度及效度,采用Spearman秩相关分析CAT评分与SGRQ评分、CAT评分与肺功能指标之间的相关性。结果 CAT的克龙巴赫α系数为0.796;CAT每个问题单项分值与总分值的Spearman秩相关系数为0.413～0.758(P<0.01);通过因子分析,最终抽取2个维度,可以解释总体方差的59.18%,各维度与量表总体的相关系数(0.960,0.549,P<0.01)大于维度间的相关系数(0.292)(P<0.01)。CAT总评分与SGRQ总评分呈显著正相关(r=0.735,P<0.01),第一秒用力呼气容积占预计值百分比(FEV1%)呈显著负相关(r=-0.441,P<0.01),与FEV1占用力肺活量(FVC)百分比(FEV1/FVC)亦呈显著负相关(r=-0.324,P<0.01)。结论中文版CAT是一种简易、可靠、有效的新型COPD患者生存质量评估问卷,可以很好地反映中国COPD患者的生存质量,适用于中国COPD患者的生存质量的评估。