Abstract
Health status is a prognostic factor included in the assessment of chronic obstructive pulmonary disease (COPD). The aim of our study was to examine the associations of clinical factors with change in health status over a 7-year follow-up period. In 2005, 970 randomly selected primary and secondary care patients with a COPD diagnosis completed questionnaires including the Clinical COPD Questionnaire (CCQ); and in 2012, 413 completed the CCQ questionnaire again. Linear regression used difference in mean total CCQ score between 2005 and 2012 as the dependent variable. Independent variables were CCQ score at baseline 2005, sex, age, educational level, body mass index (BMI), smoking status, heart disease, diabetes, depression, number of exacerbations in the previous 6 months, dyspnoea (modified Medical Research Council (mMRC)). Health status worsened from mean total CCQ (s.d.) 2.03 (1.26) in 2005 to 2.16 (1.37) in 2012 (P=0.011). In linear regression with adjustment for baseline CCQ; older age, lower education, higher mMRC and BMI below 25 kg/m2 at baseline were associated with worsened health status in 2012. When sex, age and all statistically significant measures were included simultaneously in the analysis of the main study group, higher mMRC and BMI below 25 kg/m2 were were associated with deteriorated health status (P<0.0001). A higher level of dyspnoea and lower weight were associated with worse health status in COPD. Strategies for decreasing dyspnoea and awareness of the possible increased risk of worsening disease in under- and normal-weight COPD patients are clinically important.
Highlights
According to the updated GOLD (Global Initiative for ChronicObstructive Lung Disease) recommendations, the assessment of disease severity in chronic obstructive pulmonary disease (COPD)patients should include lung function, exacerbation frequency and health status.[1]
GOLD recommends the use of concise health status instruments for clinical practice,[6] such as the COPD Assessment Test (CAT)[7] or the Clinical COPD Questionnaire (CCQ).[8]
For 42.9% of the patients, health status improved, for 51.1% of the patients health status worsened, and for 6.0% the score was unchanged after 7 years
Summary
Obstructive Lung Disease) recommendations, the assessment of disease severity in chronic obstructive pulmonary disease (COPD). Patients should include lung function, exacerbation frequency and health status.[1] Low health status is known to be associated with increased risk for re-admission to hospital and increased mortality.[2,3,4] The importance of health status in COPD was emphasised in a recent study, where patients with a 1-year improvement or stable health status as assessed by the St Georges. Respiratory Questionnaire (SGRQ) had a lower risk of exacerbations, COPD-related hospital admission or death.[5]. GOLD recommends the use of concise health status instruments for clinical practice,[6] such as the COPD Assessment Test (CAT)[7] or the Clinical COPD Questionnaire (CCQ).[8] CCQ was introduced in. It has been shown to detect improvement in health status following pulmonary rehabilitation after acute exacerbations.[9,10]
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