Quality of life of COPD patients treated by long-term oxygen

The three main dimensions of quality of life (physical function, social activities, and psychological status) were evaluated by a questionnaire in 41 COPD patients with severe respiratory failure treated by long-term oxygen. The results were compared with those obtained in patients suffering from COPD without chronic respiratory failure and in patients suffering from severe diabetes and/or atherosclerosis. A relevant impairment of the indexes of quality of life was found in the group of subjects with chronic respiratory failure. The extent of the impairment was significantly higher in these subjects than in the two other groups of patients.     

Quality of life measurements and bronchodilator responsiveness in prescribing nebulizer therapy in COPD

Nebulized bronchodilators are widely regarded as the optimal treatment for maintenance therapy in patients with severe chronic obstructive pulmonary disease (COPD). The aim of the study was to assess whether detailed physiological, functional and quality of life-related measurements can assist in determining the requirement for nebulized bronchodilator therapy in patients with moderate to severe COPD. This was an unblinded, randomized, crossover study that compared intermediate (120 mcg ipratropium bromide and 600 mcg of salbutamol using metered dose inhaler (MDI) and spacer) and high dose (nebulized 500 mcg ipratropium bromide and 2.5 mg salbutamol) bronchodilator therapy, on physiological, functional and quality of life-related measurements in patients with COPD. A total of 25 patients (12 female), mean (SD) age 68 (7) years, FEV(1) 45 (10) % predicted completed the study. There was no statistically significant difference between the treatments in the pre- and post-bronchodilator lung function values, six-minute walk distance, breathlessness score or quality of life questionnaires. Fifteen patients preferred bronchodilator therapy with nebulizer and 10 with MDI and spacer. In 20 patients at least one positive response in quality of life score, lung function or six-minute walk, was observed on the preferred treatment. Only a proportion of patients with moderate or severe COPD prefer nebulized bronchodilator therapy. This study found that none of the parameters singly or in combination were consistently predictive of patients' preference for nebulized bronchodilator therapy. Therefore, we suggest that clinicians institute a trial of stepping up to an intermediate dose of bronchodilators prior to introducing nebulized therapy.     

Activity limitation and quality of life in COPD

Limitation of activity and impaired quality of life are important outcomes of COPD. There is an association between measures of self-reported physical activity and overall health status, and they appear to change together spontaneously over time and in response to treatment. The relationship between symptoms and activity limitation is complex, because activity can be limited entirely by symptoms, or impaired by symptoms so that it requires greater effort or causes discomfort. The patient has the choice of whether to restrict their activity or maintain it at the cost of having symptoms. In theory, this may make it difficult to produce reliable standardized assessments of activity limitation because it may not be clear exactly what is being measured. Analysis of items in the St George's Respiratory Questionnaire (SGRQ) concerned with activities that are either not possible due to breathlessness, or are a cause of breathlessness, show that they contribute to a unidimensional model of activity limitation in daily life and a unidimensional model of overall COPD-related health status. The items lie distributed evenly along the same severity continuum, from very mild to very severe, along with other items concerned with symptoms and the psycho-social impact of the disease. This suggests that self-reported limitation of activity may form a reliable construct, and may also provide a good surrogate marker of health status in COPD.     

The evaluation of dyspnea and quality of life in COPD

Dyspnea defined as an uncomfortable sensation of breathing is the main cause of disability in chronic obstructive pulmonary disease (COPD) patients. There is evidence that the underlying mechanisms of dyspnea are multifactorial. The aim of this study was to investigate these mechanisms causing dyspnea in COPD patients and the relationship between functional parameters, dyspnea scales and quality of life questionnaire. For this purpose 56 patients (11 female, 45 male) were recruited. Pulmonary function tests including airflow rates, lung volumes, maximal respiratory muscle forces, diffusing capacity, breathing pattern, arterial blood gas analyses as well as dyspnea scales MRC, baseline dyspnea index (BDI) and The Saint George Respiratory Questionnaire (SGRQ) were performed. The overall group showed moderate obstructive disease (FEV1%= 59.02 +/- 3.30) and mild hypoxemia with some air trapping (RV/TLC%= 52.00 +/- 2.00). MRC scale did not show any significant correlation with pulmonary function parameters. There was significant positive correlation between BDI and airflow rates, PImax, DLCO and air trapping. Breathing pattern parameters (Ti/Ttot, VT/Ti) also correlated with BDI. There was positive correlation between PaO2 and BDI (p< 0.001). SGRQ scores correlated significantly with FEV1, PImax, RV/TLC and P 0.1. There was also strong correlation between BDI and SGRQ scores. In conclusion, dyspnea is the result of multiple factors such as airflow limitation, decreased respiratory muscle strength, changes breathing pattern, hypoxemia, and air trapping which in turn affects quality of life in patients with COPD.     

Quality of life in haemophilia

Summary.  There is a growing interest in patient-reported outcomes as measures for evaluating the benefits of new and existing treatments. Health-related quality of life (HRQoL) is one of these patient-reported outcomes and represents the individual experience and perception of illness/health together with the psychosocial response to disease-related and treatment-related symptoms. Generic and disease-specific HRQoL questionnaires enable us to assess and quantify the multi-dimensional perception of well-being, namely the physical components and the psychological (emotional, mental, social and behavioural) components of patient's well-being and functioning. These instruments should be standardized and validated and they should prove to be reliable, valid, specific and sensitive in a similar manner to instruments created for objective parameters. HRQoL assessment can help us to evaluate the benefits of new treatments from the perspective of patient's values and expectations. It can also help to evaluate the quality of care provided, in order to be able to improve it at a local and national level. Moreover, HRQoL assessment can be routinely assessed to monitor improvement and progress or deterioration and decline from the global point of view of each single patient, integrating the otherwise limited angle of objective signs and instrumental or lab parameters.     

Quality of life in acromegaly

Acromegaly is a disease with an important impact on health-related quality of life (HRQoL). Cross-sectional evaluation of HRQoL in patients with acromegaly using generic questionnaires and the specific questionnaire AcroQoL has confirmed severe impairment; active disease, female gender, ageing, disease duration, joint symptoms and prior radiotherapy are associated with worse HRQoL. The most affected dimension is appearance and the least affected, personal relations; comparable results have been observed in Spanish, Dutch, German, English and Turkish speaking patients. Patients with active acromegaly show a worse score (mean range 43-56) than those in remission (mean range 65-71). In longitudinal studies, in patients with stable acromegaly, no change was observed on retesting at 1 month, demonstrating a good test-retest reliability. In patients with active acromegaly, after 6 months of treatment, an improvement in the AcroQoL score was observed (56 +/- 20 to 66 +/- 18; p < 0.01). The internal consistency of AcroQoL was good (Cronbach's alpha >0.7). No correlation between AcroQoL and insulin-like growth factor-I/growth hormone levels was observed, even though a trend was found for the most affected dimension (appearance) and insulin-like growth factor-I (p = 0.051). In summary, HRQoL is severely affected in acromegaly, even in patients with controlled disease. Thus, to optimise management, not only biochemical and radiological parameters but also dimensions that reflect HRQoL should be evaluated in acromegaly.     

Quality of life in coughers

As coughing can cause profound physical and psychosocial complications, it has the potential to lead to a decrease in health-related quality of life (HRQoL). Two studies have prospectively shown that cough can adversely affect HRQoL. The first utilized the Sickness Impact Profile, a non-illness specific measure of health-related dysfunction that measured the effect of patients' health dysfunction on usual daily activities; it has not been psychometrically tested to assess the effects of cough. The second utilized a cough specific quality of life questionnaire that assessed the 28 most common and important reasons why patients seek medical attention because of coughing. It has been found to be a reliable and valid tool for evaluating the impact of acute and chronic cough on adult patients and a valid method by which to assess the efficacy of cough therapies for chronic cough. Because HRQoL is of the highest importance to patients and a cough specific HRQoL instrument assesses the impact of cough in a way no other type of measure does, a cough specific HRQoL instrument should be considered for routine use to optimally evaluate the impact of cough on patients and assess the efficacy of cough modifying agents.     

Depression in COPD �C management and quality of life considerations

Depression is common in COPD patients. Around 40% are affected by severe depressive symptoms or clinical depression. It is not easy to diagnose depression in COPD patients because of overlapping symptoms between COPD and depression. However, the six-item Hamilton Depression Subscale appears to be a useful screening tool. Quality of life is strongly impaired in COPD patients and patients’ quality of life emerges to be more correlated with the presence of depressive symptoms than with the severity of COPD. Nortriptyline and imipramine are effective in the treatment of depression, but little is known about the usefulness of newer antidepressants. In patients with milder depression, pulmonary rehabilitation as well as cognitive-behavioral therapy are effective. Little is known about the long-term outcome in COPD patients with co-morbid depression. Preliminary data suggest that co-morbid depression may be an independent protector for mortality.     

Co-Morbidity,Body Mass Index and Quality of Life in COPD Using the Clinical COPD Questionnaire

Introduction: Quality of life is an important patient-oriented measure in COPD. The Clinical COPD Questionnaire (CCQ) is a validated instrument for estimating quality of life. The impact of different factors on the CCQ-score remains an understudied area. The aim of this study was to investigate the association of co-morbidity and body mass index with quality of life measured by CCQ. Methods: A patient questionnaire including the CCQ and a review of records were used. A total of 1548 COPD patients in central Sweden were randomly selected. Complete data were collected for 919 patients, 639 from primary health care and 280 from hospital clinics. Multiple linear regression with adjustment for sex, age, level of education, smoking habits and level of care was performed. Subanalyses included additional adjustment for lung function in the subgroup (n = 475) where spirometry data were available. Results: Higher mean CCQ score indicating lower quality of life was statistically significant and independently associated with heart disease (adjusted regression coefficient (95%CI) 0.26; 0.06 to 0.47), depression (0.50; 0.23 to 0.76) and underweight (0.58; 0.29 to 0.87). Depression and underweight were associated with higher scores in all CCQ subdomains. Further adjustment for lung function in the subgroup with this measure resulted in statistically significant and independent associations with CCQ for heart disease, depression, obesity and underweight. Conclusion: The CCQ identified that heart disease, depression and underweight are independently associated with lower health-related quality of life in COPD.     

Quality of life at end of life

Patients with chronic kidney disease, particularly those with diabetes, often have a heavy burden of vascular comorbidity and hence a poor overall prognosis. Unfortunately, patients and their healthcare teams often have unrealistic expectations about outcomes and receive ineffective and often harmful interventions towards their end of life. We need to move away from death being perceived as a failure and realise, instead, that our goal of care at the end of life is to achieve as good a quality of life for the patient as possible. To be able to achieve this, it is important to be realistic about prognosis, be able to recognise predictors of poor outcome and then be able to discuss these with the patient and their family to ensure symptom control, avoid interventions that could do harm and then as the end approaches, determine the wishes of the patient regarding preferred place of care for their inevitable death.     

Quality of life measured with a generic instrument (Short Form-36) improves following pulmonary rehabilitation in patients with COPD

STUDY OBJECTIVES: The purpose of this study was to evaluate the effects of a 3-week comprehensive pulmonary rehabilitation program on quality of life as measured by the Short Form-36 (SF-36) in patients with COPD. DESIGN AND SETTING: We report on the outcomes of 37 consecutive patients referred for pulmonary rehabilitation at a respiratory specialty medical center. PATIENTS: Thirty-seven patients (mean age, 66 years) with COPD and severe airflow limitation (mean +/- SE FEV(1), 29.6 +/- 1.8% of predicted) were studied. INTERVENTIONS: Rehabilitation consisted of a 3-week pulmonary rehabilitation program incorporating 12 exercise sessions, each of which included bicycle ergometer exercise training, upper-extremity training, strength training, and stretching, along with psychosocial counseling and education. MEASUREMENTS AND RESULTS: The Health Status Index (SF-36) and 6-min walk test were completed before and after rehabilitation. There was an improvement in five of the nine quality-of-life subscales of the SF-36 following pulmonary rehabilitation. Although there was an improvement in functional capacity as measured by the 6-min walk, there was no correlation between improvement in quality of life and improvement in functional capacity. There was no correlation between FEV(1) and improvement in walk distance, but there was a correlation between FEV(1) and improvement in SF-36 physical function and energy/fatigue subscales. CONCLUSION: Health-related quality of life assessed by the SF-36, a general measure of quality of life, improves following an intensive 3-week pulmonary rehabilitation program. Use of the SF-36 allows comparison of the results of pulmonary rehabilitation to therapeutic interventions in patients with other medical disorders.     

Content comparison of health-related quality of life instruments for COPD

BACKGROUND: Due to the increasing importance of quality of life assessments in chronic obstructive pulmonary disease (COPD) patients, and the increased use of the International Classification of Functioning, Disability and Health (ICF) for comparative purposes it is essential to understand the relationship between health-related quality of life (HRQL) instruments and the ICF. OBJECTIVE: The objective of this study was to compare the content of recommended COPD-specific HRQL instruments using the ICF as reference. COPD-specific instruments mentioned in widely accepted guidelines were linked to the ICF using standardized linking rules. The degree of agreement between various health professionals was assessed by calculating the kappa statistic. RESULTS: Eleven instruments were included. They varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. A total of 548 concepts were identified and linked to 60 different ICF categories. Only the single category 'dyspnea' was covered by all instruments, whilst 21 categories were unique to specific instruments. The relationships of the measures with the ICF were identified. CONCLUSIONS: This study may aid researchers and clinicians to choose the most appropriate instrument for a specific purpose as well as help compare studies that have used different instruments for HRQL assessment.