Fluctuating patterns in quality of life outcomes among patients with moderate and severe stages of chronic obstructive pulmonary disease.

Abstract

How changes in depression and anxiety and well-being may fluctuate with changes in disease-specific quality of life (QOL), and further how changes in well-being may fluctuate with changes in depression and anxiety among patients with moderate and severe chronic obstructive pulmonary disease (COPD). In a longitudinal study (as part of a randomized controlled trial), we investigated 150 patients with moderate and severe COPD at baseline, 143 at 4weeks, and 130 at 4months. Lung function was tested, and a questionnaire was completed at all appointments. The questions captured demographic variables, disease-specific QOL (St. George's Respiratory Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale), and well-being (World Health Organization-5 Well-being Index). Multiple regression analyses were performed. At 4weeks and 4months, changes in disease-specific QOL (st. β=-0.35, p<0.001, partial (p) R (2)=11-12%), depression (st. β=-0.32 to -0.36, p<0.001, pR (2)=9-12%), and anxiety (st. β=-0.21 to -0.40, p<0.02-0.001, pR (2)=4-15%) were significantly associated with changes in well-being. Changes in disease-specific QOL were significantly associated with changes in anxiety at 4months (st. β=0.21, p=0.02, pR (2)=4%), but not with changes in depression. Changes in disease-specific QOL, depression, and anxiety were associated with changes in well-being. Changes in disease-specific QOL contributed slightly to changes in anxiety, but not to changes in depression. Well-being may capture some aspects of mental QOL in COPD patients better than depression and anxiety.