Abstract
PurposeQuality-of-life (QoL) scores in chronic obstructive pulmonary disease (COPD) have a weak relationship with physiologic impairment. We investigated factors associated with poor QoL, focusing on psychological measures potentially amenable to intervention.Patients and methodsWe utilized a pre-existing Birmingham (UK) COPD cohort to assess factors associated with QoL impairment (COPD Assessment Test [CAT] scores). Univariate and multivariate regression models were constructed from three categories of variables: demographic, lung function/COPD-related symptoms, and psychosocial/behavioral factors.ResultsAnalyses were based on self-report questionnaire data from 735 participants. The multivariate model of variables independently associated with CAT included depression, dysfunctional breathing symptoms (Nijmegen score), and illness perception, in addition to COPD symptoms (wheeze, cough), exercise capacity, breathlessness, exacerbations, and deprivation; this model explained 72% of CAT score variation. In a dominance analysis assessing the relative contribution of variables, similar contributions were made by breathlessness (20.2%), illness perception (19.8%), dysfunctional breathing symptoms (17.5%), and depression (12.5%) with other variables contributing <5%.ConclusionPsychological factors significantly contribute to disease-specific QoL impairment in COPD, and potentially explain the mismatch between objective physiologic impairment and patients’ experience of their disease. Interventions targeting psychological factors, illness perception, and dysfunctional breathing should be assessed.
Highlights
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and a global public health problem.[1]
The current analysis investigated factors independently influencing disease-specific QoL16 and generic health-related (HR) QoL score using the 5 level EuroQoL questionnaire (EQ-5D 5L),[17] and estimated the magnitude of contribution of different contributory factors, with a particular focus on clarifying the relative contribution of psychosocial and behavioral factors
We considered variables within three categories: 1) demographic characteristics; 2) COPD-related factors (FEV1% predicted, physical activity, chronic cough/phlegm, chronic wheeze, breathlessness, exacerbations, hospitalizations); and 3) psychosocial and behavioral factors
Summary
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and a global public health problem.[1] As a complex, multifaceted disease, it affects patients in many ways and results in significant quality-of-life (QoL) impairment.[2] However, QoL varies greatly between individuals, and is only weakly associated with physiologic factors such as percentage predicted forced expiratory volume in 1 second (FEV1).[3] Anxiety and depression are common, although frequently unrecognized and untreated,[4] and are associated with poor COPD outcomes.[5,6,7] Previous research suggests that a variety of disease-related and patient-related factors may be associated with QoL impairment in COPD.[3] In addition to biologic factors (such as lung function and inflammation) and demographic/socioeconomic factors, there is evidence that QoL is affected by comorbidities, particularly psychological conditions,[8,9,10,11] submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/COPD.S152955
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