Abstract
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.
Highlights
The number of people with chronic diseases and multiple comorbidity is growing with increasing life expectancy [1,2]
Chronic airway diseases characterized by airflow obstruction (AO), such as asthma or chronic obstructive pulmonary disease (COPD), contribute significantly to worldwide morbidity [3,4] with a significant impact on health status in the general population
physical component summary (PCS) and mental components (MCS) were confirmed as a valid instrument for the assessment of quality of life related to physical and mental health, respectively [47], whereas social functioning (SF)-36 has generally been used in many studies [48,49] as a useful tool for clinical management
Summary
The number of people with chronic diseases and multiple comorbidity is growing with increasing life expectancy [1,2]. Primary health care and general practitioners have a crucial role in the diagnosis and management of chronic airway disease [6]. In this context, dyspnea was one of the main symptoms, only second to pain; it is estimated that up to a quarter of the general population is affected by it [7,8,9]. In adults with airflow obstruction, such as COPD patients, dyspnea is reported as the most important determinant of a low physical and mental health component [11,12], influencing daily life functions [13]. Patients with comorbidities had a poor self-reported health status [15] and a poorer quality of life [16]
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