Quality Of Life In Chronic Obstructive Pulmonary Disease Research Articles

Comorbid Influences on Generic Health-Related Quality of Life in COPD: A Systematic Review.

BackgroundChronic obstructive pulmonary disease (COPD) is a leading cause of mortality and of loss of disability-adjusted life years worldwide. It often is accompanied by the presence of comorbidity.ObjectivesTo systematically review the influence of COPD comorbidity on generic health-related quality of life (HRQoL).MethodsA systematic review approach was used to search the databases Pubmed, Embase and Cochrane Library for studies evaluating the influence of comorbidity on HRQoL in COPD. Identified studies were analyzed according to study characteristics, generic HRQoL measurement instrument, COPD severity and comorbid HRQoL impact. Studies using only non-generic instruments were excluded.Results25 studies met the selection criteria. Seven studies utilized the EQ-5D, six studies each used the SF-36 or SF-12. The remaining studies used one of six other instruments each. Utilities were calculated by four EQ-5D studies and one 15D study. Patient populations covered both early and advanced stages of COPD and ranged from populations with mostly stage 1 and 2 to studies with patients classified mainly stage 3 and 4. Evidence was mainly created for cardiovascular disease, depression and anxiety as well as diabetes but also for quantitative comorbid associations. Strong evidence is pointing towards the significant negative association of depression and anxiety on reduced HRQoL in COPD patients. While all studies found the occurrence of specific comorbidities to decrease HRQoL in COPD patients, the orders of magnitude diverged. Due to different patient populations, different measurement tools and different concomitant diseases the study heterogeneity was high.ConclusionsFacilitating multimorbid intervention guidance, instead of applying a parsimony based single disease paradigm, should constitute an important goal for improving HRQoL of COPD patients in research and in clinical practice.

The risk and outcomes of pneumonia in patients on inhaled corticosteroids

Corticosteroids are frequently prescribed anti-inflammatory medications. Inhaled corticosteroids (ICS) are indicated for Chronic Obstructive Pulmonary Disease (COPD) and asthma. ICS are associated with a decrease in exacerbations and improved quality of life in COPD, however multiple studies have linked the chronic use of ICSs with an increased risk of developing pneumonia, though the effect on mortality is unclear. We review the association of ICS with the risk of pneumonia and the implications on clinical outcomes.

A Study on Assessment of Health Related Quality of Life in COPD and Asthma Patients in a Tertiary Care Teaching Hospital

Aim: The aim of this study was to evaluate the association between health-related quality of life (HRQL) and disease severity using both disease specific and generic specific questionnaires and lung function measures. Methods: A survey was performed in patients with COPD and Asthma in tertiary care teaching hospital. One hundred and twenty (120) subjects (92 men and 28 women, mean age 48.6 years) completed the generic HRQL questionnaire; the Short Form 36 (SF-36) and disease-specific HRQL questionnaire; the St George's Respiratory Questionnaire (SGRQ). The subjects were divided into four severity groups according to FEV 1 percent of predicted normal using two clinical guidelines: GOLD and BTS. Results: From our study it was observed that the mean scores of SF-36 PCS is 40.46, p<0.0001 and MCS is 40.22, p<0.0001which showed an average HRQL and was significantly associated with COPD and Asthma. The COPD severity grades affected the SGRQ Total scores, varying from 67.8 to 22.9 (GOLD p<0.0001) and from 64.1 to 22.9 (BTS p<0.0001). The four stages of FVC% predicted had an impact on HRQL similar to the stages of FEV 1 % predicted outlined from GOLD and BTS. Strong negative correlation (-0.645, p<0.0001) was observed between SF-36 and SGRQ total scores, strong negative correlation (-0.847, p<0.0001) between SGRQ total scores and FEV 1 %/FVC% predicted in contrast with positive correlation (0.583, p<0.0001) with SF-36 and FEV 1 %/FVC% predicted. Conclusion: The results showed that HRQL in COPD deteriorates with disease severity and age. The results also showed that the level of HRQL of COPD and Asthma subjects deteriorate considerably with increase in the severity of disease and such deterioration showed linear relation to the decrease in the FEV 1 % predicted normal values.

Aclidinium bromide/formoterol fixed-dose combination therapy for COPD: the evidence to date.

The quest for the right combination of bronchodilators with different mechanisms of action such as long-acting muscarinic antagonists and long-acting β-agonists in the management of stable moderate-to-severe chronic obstructive pulmonary disease (COPD) is a topic of intense research activity currently, given the rising morbidity and mortality due to this disease. The fixed-dose combination of aclidinium bromide and formoterol fumarate in a single inhaler seems to offer superior advantages over either drugs given alone or as separate inhalers concurrently. Since the fixed-dose combination needs to be given twice daily, it is likely to achieve control of symptoms most crucial to the quality of life in COPD, namely, the morning hours. This is reflected in significant trough FEV1 (forced expiratory volume in 1 second) improvements after the dose. This paper reviews the various studies related to this combination put in the perspective of its safety and efficacy and potential benefits over other therapeutic options. However, there is a dearth of data on the long-term safety and efficacy in terms of improvement in lung function. This combination could emerge as an excellent option in the management of stable COPD if data on exacerbation rates and patient-reported outcomes become available from longer-term studies. Moreover, we need some more studies to define the ideal phenotype of COPD best suited for the use of this combination.

Serum magnesium and not vitamin D is associated with better QoL in COPD: A cross-sectional study

Deficiency of serum levels of vitamin D3 (se vitD), magnesium (se Mg) and calcium (se Ca) may be associated with increased exacerbation risk in chronic obstructive pulmonary disease (COPD). However, associations with other aspects of COPD, e.g. lung function and quality of life (QoL), have been studied less extensively. To investigate se vitD, se Mg and se Ca in COPD and their associations with both forced expiratory volume in 1st second (FEV1) and QoL. FEV1 and se vitD (assessed by 25-(OH)-D3), se Mg and se Ca were measured during summertime. Generic and health related QoL were characterized. This cross-sectional study included 143 participants with COPD. Women had a significantly higher se vitD than men (P=0.0028), and 27% of participants were se vitD deficient. FEV1 was not correlated with se vitD, se Mg or se Ca in COPD. Mg deficiency group reported significantly impaired mobility, usual activities, pain/discomfort and COPD-related QoL. Se vitD and se Ca were not associated with QoL. Serum levels of vitD, Mg and Ca were not related to FEV1. Most participants in this study were vitD-, Mg- and Ca sufficient. Women had higher se vitD than men. Se Mg, but not se vitD and se Ca, was associated with QoL in COPD. Prospective randomized studies are needed to substantiate these finding. Clinical trials ID at www.clinicaltrials.gov: NCT01564953.

Correlation between functional capacity and health-related quality of life in COPD: a case series

Objective To correlate functional capacity test scores from chronic obstructive pulmonary disease (COPD) subjects with their functional state as assessed by health-related quality of life questionnaires (one respiratory disease-specific [SGRQ] and one generic [SF-36] questionnaire). Materials and methods Study of a case series of 8 COPD patients. The following tests were performed: 1) Six-minute walk test (6-MWT); 2) Shuttle walking test (SWT); 3) Six-minute step test (6-MST); 4) Two-minute sit-to-stand test (STST); and 5) Pegboard and ring test (PBRT). Besides these tests, two health-related quality of life questionnaires were administered: The St George's Respiratory Questionnaire (SGRQ) and the Short Form 36 (SF-36) health survey questionnaire. The statistical analysis was carried out by using the Shapiro-Wilk normality test, while correlations were assessed using Pearson's (parametric data) or Spearman's (non-parametric data) rank tests, with p &lt; 0.05. Results The 6-MWT showed strong correlation with the SF-36 scales of physical functioning, general health, vitality, social functioning and mental health. Conversely, the other functional capacity tests showed no correlation with this questionnaire. The SGRQ showed no correlation with any of the tests. Conclusions The 6-MWT may be a good test to reflect the health-related quality of life of COPD subjects.

P249 Effect Size Of Open-label Versus Double-blind Administration Of Tiotropium In Trials Investigating Health-related Quality Of Life In Copd

Introduction Effects of interventions on patient-reported outcomes may be subjective and modulated by patients’ expectations regarding treatment efficacy. The ‘gold standard’ for minimising such biases are double-blind randomised controlled trials. We analysed the effects of tiotropium on health-related quality of life in chronic obstructive pulmonary disease (COPD) in placebo-controlled trials and assessed whether trial design (double-blind versus open-label) is a relevant modifier of the effects of tiotropium. Methods Trials of ≥6 months’ duration investigating the effect of tiotropium versus placebo on health-related quality of life in COPD (assessed using St George’s Respiratory Questionnaire [SGRQ]) were identified from the Boehringer Ingelheim clinical trial database and by a systematic literature search in MEDLINE, with a cut-off date of 30 November 2011. As a clinical end point, the mean difference between treatment groups in SGRQ total score was assessed. Trials were grouped according to double-blind or open-label design. We performed a network meta-analysis including standard methodology to test for interaction to evaluate whether trial design is a potential modifier of effect size or its direction. Results We identified 12 trials in which tiotropium had been administered double-blind and three trials with open-label application. The overall effect for mean difference versus placebo in SGRQ total score was -2.98 units (95% confidence interval [CI): -3.49, -2.47). For the double-blind trial subgroup, mean difference versus placebo was -3.20 (95% CI: -3.75, -2.65) compared to -1.67 (95% CI: -3.02, - 0.32) for open-label trials. The p-value for interaction between subgroup and effect on SGRQ total score was 0.04. Conclusions In patients with COPD, trial design (double-blind versus open-label) was a statistically significant modifier of the effect of inhaled tiotropium on health-related quality of life. The modification was quantitative, resulting in a substantial underestimation of the effect of tiotropium on SGRQ total score when the administration had been open-label compared to the ‘gold standard’ double-blind. A subjective end point such as quality of life is particularly susceptible to bias due to patients’ expectations towards the efficacy of an intervention. Therefore, the validity of studies using non-blinded designs to investigate such end points must be questioned.

Factors Contributing to Quality of Life in Copd in South Korea.

Factors Contributing to Quality of Life in Copd in South Korea.

Relationship between the functional status constructs and quality of life in COPD

Introduction Functional status is an important component of health related quality of life (QOL) in patients with chronic obstructive pulmonary disease (COPD). However there is a lack of studies aiming to evaluate the association between QOL and the different methods for assessing patient´s limitation to perform ADL. Objectives To investigate the association between QOL and functional status, measured by four different instruments: London Chest Activity of Daily Living scale (LCADL), six-minute walking test (6MWT), Glittre ADL-test (TGlittre) and assessment of physical activities in daily living (PADL). Methods Twenty-three patients with COPD, GOLD 2 to 4, were submitted to the following evaluations: spirometry, the Saint George Respiratory Questionnaire (SGRQ), LCADL, 6MWT, TGlittre and assessment of PADL. Pearson or Spearman correlation coefficients were used to verify the association between the variables. Results It was observed correlation between all domains of the SGRQ and the 6MWT, between TGlittre and ‘leisure’ domain of LCADL; and between the domain ‘activity’ of the SGRQ with the total score of LCADL (r = 0.53), LCADL% (r = 0.54), ‘self care’ (r = 0.49) and ‘leisure’ (r = 0.82). The number of steps correlated with the SGRQ (r = -0.59) and with ‘activity’ (r = -0.70) and ‘impact’ (r = -0.52) domains. The standing time correlated with the domain ‘activitiy’ (r = -0.47) of the SGRQ (p &lt; 0.05 for all). Conclusions Both functional performance and capacity are able to reflect the impact that ADL limitation has on QOL in patients with COPD

Quality of Life in Chronic Obstructive Pulmonary Disease: An Evolutionary Concept Analysis.

To explore the concept of quality of life (QoL) of people with chronic obstructive pulmonary disease (COPD) in the nursing context. The issue of QoL takes on a leading role in the COPD field because it is an incurable pathology. Despite its relevance, this concept is quite ambiguous, and there is no consensus of opinion in the literature regarding its definition. Rodgers' method of evolutionary concept analysis was employed to delineate and clarify the concept of QoL in COPD. An electronic review was made on scientific databases from 2008 to 2013. The 75 selected articles were analyzed in order to highlight the main themes related to QoL concept. The QoL appears as a dynamic and multidimensional concept that evolves with the progression of the pathology and the impairment of health status. It has both subjective and objective characteristics, intrinsic and extrinsic elements. This analysis provides an overview of the QoL concept related to COPD patients that is useful as a guide to research into nursing care and for clinical practice.

Chronic Obstructive Pulmonary Disease and its association with sleep and mental disorders in the general population

ObjectiveTo assess the prevalence of insomnia symptoms in Chronic Obstructive Pulmonary Disease (COPD) participants, their association with psychiatric disorders and their impact on health care utilization and quality of life. MethodIt is a cross-sectional telephone study using a representative sample consisting of 10,854 non-institutionalized individuals aged 15 or over living in Germany, Spain and the United Kingdom. Interviews were managed by the Sleep-EVAL expert system. The questionnaire included questions on sleeping habits, life habits, health, DSM-IV mental disorders, DSM-IV and ICSD sleep disorders. COPD was defined as chronic bronchitis or emphysema (treated or not) diagnosed by a physician. ResultsA total of 2.5% [2.1%–2.8%] of the sample reported having been diagnosed with COPD. As many as 48.1% of COPD had insomnia symptoms, which was twice higher than the rate observed in non-COPD (OR: 2.4). Only 11.8% of COPD addressed their sleep difficulties to their physician. Mental disorders were higher in COPD compared to non-COPD participants: Major Depressive disorder (AOR: 2.8); Generalized Anxiety Disorder (AOR: 11.0); Panic Disorder (AOR: 7.1) and Specific Phobia (AOR: 3.7). As many as 84.4% of COPD with depression and 59.7% of those with an Anxiety Disorder had associated insomnia symptoms. The co-occurrence of both conditions increased by five times the likelihood of hospitalizations in the previous year among COPD. Both conditions were associated with a diminished Quality of Life in COPD. ConclusionsCOPD is a debilitating disease accompanied with psychiatric disorders and sleep disturbances in the overwhelming majority of cases. This high comorbidity is associated with greater health care utilization and great deterioration of the quality of life.

PRS47 - Relationship Between Medication Adherence and Quality of Life in COPD – Systematic Review

PRS47 - Relationship Between Medication Adherence and Quality of Life in COPD – Systematic Review

Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD

Combination inhaled corticosteroid/long-acting bronchodilator (ICS/LABA) therapy reduces the exacerbation rate and improves spirometry and quality of life in COPD. We hypothesized that ICS/LABA therapy also improves small airway function measured by FOT. 14 subjects with COPD were commenced on combination fluticasone propionate/salmeterol therapy for 3 months. At baseline, subjects completed the St George Respiratory Questionnaire (SGRQ) and underwent standard pulmonary function tests as well as forced oscillation technique (FOT) and single and multiple breath nitrogen washouts. All tests were repeated at the completion of 3 months of therapy. Subjects were of mean (SD) age 65.9 years (8.4), BMI 30.0 (5.6), pack years 51.4 (21.1), post-bronchodilator FEV1% predicted 62.7 (20). At baseline, mean SGRQ total was 39.0 (17.7) and FRC% predicted 125.4 (31.3). From FOT, Rrs-total was 5.69 (1.29)cmH2O/L/s, Xrs-total -3.48 (2.16)cmH2O/L/s, EFL Index 3.51 (2.45)cmH2O/L/s. After 3 months of therapy, there were significant improvements in SGRQ score (-13.81, p<0.0001) despite no change in FEV1 (+40mL, p=0.14). From FOT, total resistance (-0.63cmH2O/L/s, p=0.0004), reactance (+1.2cmH2O/L/s, p=0.013), and expiratory flow limitation (-1.21cmH2O/L/s, p=0.02) also improved. There were no significant changes in ventilation heterogeneity indices. Combination therapy is associated with improvements in small airways function in COPD, despite an absence of change in FEV1. FOT may be a clinically useful marker of small airway function in COPD that is responsive to treatment.

Effect of thyroid function on COPD exacerbation frequency: a preliminary study

BackgroundFrequent exacerbations of chronic obstructive pulmonary disease (COPD) have negative effects on quality of life and survival. Thus, factors related to exacerbations should be determined. We aimed to evaluate the effects of thyroid function on quality of life and exacerbation frequency in COPD patients.MethodsThe study population (n = 128) was divided into 3 groups (Group 1: COPD patients with hypothyroidism (n = 44); Group 2: COPD patients with normal thyroid function tests (n = 44); Group 3: Healthy subjects (n = 40)). Pulmonary function tests, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measurements were performed. Quality of life questionnaire (Short Form 36, SF-36) was carried out. Patients were followed up for one year and number of exacerbations was recorded.ResultsFVC, FEV1/FVC, and FEF 25–75% measurements were statistically different between group 1 and 2 (p = 0.041, p = 0.001, p = 0.009 respectively). Although MEP values were significantly different between group 1 and 2 (p = 0.006), there was no significant difference in MIP values between groups (p = 0.77). Quality of life scores in group 1 and 2 were significantly lower than control group. Exacerbation frequency was significantly higher in group 1 than in group 2 (p = 0.017). TSH values and exacerbation frequency had positive correlation (p < 0.0001; r = 0.82).ConclusionsThe results of the present study suggest that thyroid function has an effect in exacerbation frequency of COPD. Decrease in exacerbation numbers with early detection of impairment in thyroid function will have positive contribution on quality of life in COPD patients.

Efficacy of Yoga on Inflammatory Markers, Dyspnea, and Quality of Life in COPD

Efficacy of Yoga on Inflammatory Markers, Dyspnea, and Quality of Life in COPD

Relation Between Bacterial Infections, Exacerbations, and Quality of Life in COPD

SESSION TITLE: COPD Treatment Posters

Determinants of health related quality of life in a sample of patients with chronic obstructive pulmonary disease in Nigeria using the St. George's respiratory questionnaire.

Chronic Obstructive Pulmonary Disease (COPD) is a multi-systemic and progressive disease. However the determinants of its impact on health related quality of life are not well-studied or understood in Nigeria. To assess the determinants of health related quality of life in COPD. Patients with stable COPD were recruited consecutively from the outpatient clinics of a university hospital. Health Related Quality of Life (HRQL) was assessed using the St. George's Respiratory Questionnaire (SGRQ) and the Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) were measured by a vitalograph spirometer. Fifty patients were recruited for this study (male = 60%). The mean (SD) age was 69 (9) years. The overall mean (SD) SGRQ scores was 45.9 (26.5), 50.6 (29.2), 29.7 (19.9), 38.8 (22.0) for the symptom, activity, impact and total scores respectively. After adjusting for age, sex and smoking, self-reported breathlessness independently predicted on average 25.2, 36.8, 13.65 and 22.9 points increase in SGRQ symptom, activity, impact and total scores respectively. Self-reported weight loss predicted 12.2 points increase in the impact subscale. Self-reported breathlessness and weight loss are independent predictors of low HRQL score in COPD.

Predictors of survival in patients with chronic obstructive pulmonary disease receiving long-term oxygen therapy

AimChronic obstructive pulmonary disease (COPD) affects 2–4% of the UK's population and has significant mortality, however prognostication is difficult. Long-term oxygen therapy (LTOT) has been identified by the Gold Standards...

COPD Surveillance—United States, 1999-2011

This report updates surveillance results for COPD in the United States. For 1999 to 2011, data from national data systems for adults aged ≥ 25 years were analyzed. In 2011, 6.5% of adults (approximately 13.7 million) reported having been diagnosed with COPD. From 1999 to 2011, the overall age-adjusted prevalence of having been diagnosed with COPD declined (P = .019). In 2010, there were 10.3 million (494.8 per 10,000) physician office visits, 1.5 million (72.0 per 10,000) ED visits, and 699,000 (32.2 per 10,000) hospital discharges for COPD. From 1999 to 2010, no significant overall trends were noted for physician office visits and ED visits; however, the age-adjusted hospital discharge rate for COPD declined significantly (P = .001). In 2010 there were 312,654 (11.2 per 1,000) Medicare hospital discharge claims submitted for COPD. Medicare claims (1999-2010) declined overall (P = .045), among men (P = .022) and among enrollees aged 65 to 74 years (P = .033). There were 133,575 deaths (63.1 per 100,000) from COPD in 2010. The overall age-adjusted death rate for COPD did not change during 1999 to 2010 (P = .163). Death rates (1999-2010) increased among adults aged 45 to 54 years (P < .001) and among American Indian/Alaska Natives (P = .008) but declined among those aged 55 to 64 years (P = .002) and 65 to 74 years (P < .001), Hispanics (P = .038), Asian/Pacific Islanders (P < .001), and men (P = .001). Geographic clustering of prevalence, Medicare hospitalizations, and deaths were observed. Declines in the age-adjusted prevalence, death rate in men, and hospitalizations for COPD since 1999 suggest progress in the prevention of COPD in the United States.

Effectiveness of Bufei Yishen Granule (补肺益肾颗粒) combined with acupoint sticking therapy on quality of life in patients with stable chronic obstructive pulmonary disease

To evaluate the efficacy of Bufei Yishen Granule BFYSG) combined with Shufei Tie acupoint sticking therapy on quality of life of patients with stable chronic obstructive pulmonary disease (COPD). A multi-center, double-blinded, double-dummy and randomized controlled method was adopted in this trial. A total of 244 patients were randomly assigned to a trial group and a control group according to the random number, each with 122 patients; treatment allocation occurred when the participants met the inclusion criteria and signed the informed consent form. In the trial group, patients were treated with BFYSG combined with "Shufei Tie" acupoint sticking therapy and sustained-release theophylline dummy, and in the control group patients were treated with oral sustained-release theophylline and BFYSG dummy combined with "Shufei Tie" acupoint sticking therapy dummy. The therapeutic course for two groups was 4 months and the follow-up was 6 months. The frequency and duration of acute exacerbation calculated by adding up each frequency and duration of acute exacerbation in treatment and follow-up time respectively, the quality of life measured by the World Health Organization Quality of Life (WHOQOL)-BREF scale and adult COPD quality of life (COPD-QOL) scale were observed. Among the 244 enrolled patients, 234 were screened for full analysis set (FAS); 221 were screened for per-protocol analysis set (PPS). After 4-month treatment and 6-month follow-up there were differences between the trial group and the control group in frequency of acute exacerbation (FAS: P=0.013; PPS: P=0.046); duration of acute exacerbation (FAS: P=0.005; PPS: P=0.006); scores of physiological, psychological and environment aspects of the WHOQOL-BREF questionnaire (FAS: P=0.002, P=0.006, P=0.000; PPS: P=0.00, P=0.001, P=0.000); scores of daily living ability, social activity, depression symptoms aspects of the COPD-QOL questionnaire (FAS: P=0.000, P=0.000, P=0.006; PPS: P=0.002, P=0.001, P=0.001). BFYSG combined with acupoint sticking therapy could improve the quality of life of patients with stable COPD.