Abstract
BackgroundPatients with COPD need to cope with a disabling disease, which leads to health status impairment.AimTo investigate the long term change of health status in subjects with mild to moderate airflow obstruction and to compare this to subjects without airflow obstruction, with and without a smoking history. Second, to investigate the factors potentially associated to rapid health status decline in our total cohort.MethodsTwo hundred and one subjects were included. Generic [Short form 36 health survey (SF36) and EuroQol - 5 dimensions (EQ-5D)] and disease specific [Clinical COPD questionnaire (CCQ) and COPD Assessment Test (CAT)] health status questionnaires were regularly repeated over a six years period. Other functional outcomes comprised measures of lung function, physical fitness, physical activity and emotional state.ResultsOn average, health status decline did not differ between groups with the exception of the EQ-5D index, which deteriorated faster in subjects with airflow obstruction compared to the never smoking control group [− 0.018(0.008) versus 0.00006(0.003), p = 0.03]. Subjects presenting at least one exacerbation had faster rate of deterioration measured with CAT [0.91(0.21) versus − 0.26(0.25), p < 0.01]. Characteristics of the fast declining group were older age, worse lung function, physical fitness, physical activity and disease specific baseline health status. Subjects with airflow obstruction had a 2.5 (95% CI 1.36–4.71) higher risk of presenting fast overall health status decline. Fast overall decline was associated with the presence of acute exacerbation(s) (44% of the subjects with exacerbation(s) versus 17% of subjects without exacerbation, p = 0.03). Changes in fat free mass, functional exercise capacity and in symptoms of anxiety and depression correlated weakly to changes in health status measured with all questionnaires.ConclusionSubjects with mild airflow obstruction present a significant deterioration of health status, which is generally not much faster compared to smoking and never smoking controls. Subjects with fast decline in overall health status are older and more likely to have airflow obstruction, acute respiratory exacerbation(s), reduced physical fitness, physical activity and impaired COPD specific health status at baseline.Trial registrationNCT01314807 - retrospectively registered on March 2011.
Highlights
Patients with Chronic Obstructive Pulmonary Disease (COPD) need to cope with a disabling disease, which leads to health status impairment
Subjects with mild airflow obstruction present a significant deterioration of health status, which is generally not much faster compared to smoking and never smoking controls
Drop-out rate was smaller in the never smoking control group than in the smoking control and airflow obstruction groups (6% versus 30 and 31%, p < 0.001). Those who dropped out had higher smoking history and presented worse lung function, functional exercise capacity, symptoms of anxiety and health status (Additional file 1: Table S1)
Summary
Patients with COPD need to cope with a disabling disease, which leads to health status impairment. Health status is one of the recommended targets in the management of Chronic Obstructive Pulmonary Disease (COPD). Patients suffering from COPD present persistent airflow limitation, and systemic consequences, such as muscle dysfunction, impaired exercise tolerance, symptoms of dyspnea and fatigue and impaired health status [2]. Undiagnosed subjects already have a decreased health status compared to healthy controls. It is likely that (the perception of) a deteriorated health status is a trigger for patients to seek for medical attention. It has already been shown that patients with COPD are more likely to be referred to a respiratory specialist if they experience poor health status [6]
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