COPD: On Evaluating the Risk for Functional Decline

Abstract

Chronic obstructive pulmonary disease (COPD) is an important cause of chronic morbidity and mortality worldwide. It is characterized by chronic pulmonary and extrapulmonary manifestations with great impact on patients’ health, functional impairment, decrease in quality of life and need for prolonged assistance as well as the risk of becoming dependent on others. The aim of this study is to identify COPD patients with the risk of becoming dependent on others to perform activities of daily living (ADL), in order to provide them early intervention and assistance. The study is longitudinal, observational, quantitative and correlational. An intentional sample was used, consisting of patients diagnosed with COPD, clinically stable for at least 3 weeks, who were or had been on a pulmonary rehabilitation program at the Pulmonary Rehabilitation Unit of Hospital Pulido Valente. The IMPALA score is obtained through a questionnaire of self-reported performance for 20 Activities of Daily Living (ADL), assessing the dependent/independent status and four possible early signs of risk of dependence: taking longer to do the activities, reporting difficulty in doing them, having to take breaks while doing them or doing them less frequently. This score was compared with sociodemographic factors, pulmonary function testing (\(FEV_1\)), the 6-min walking test (6 MWT) and a disease health-related quality of life score (CAT score). Statistical analysis was performed using exploratory data analysis, visualization techniques and correlation analysis using R. With respect to disease characteristics and ADL performance (IMPALA score), COPD Grade D patients showed the worst ADL performance at basal time and a substantial variation at 6 months. Grades A, B and C had most ADL performances close to full capacity and showed little variation after 6 months. ADL performance after 6 months was worse in patients with frequent exacerbations and, although there was no significant correlation to age, older patients tended to improve ADL performance after 6 months. We found a weak correlation between the IMPALA score and exercise functional capacity, but a good correlation with basal health-related quality of life (CAT score). In conclusion, IMPALA score seems to be an additional disease marker evaluating the impact on current functional capacity, well suited to show early risk of incapacity in this group of COPD patients.