Abstractnot differ from men in Symptom scores on the SGRQ but differed markedly on the Background -There is some evidence that Activity and Impact scales. quality of life (QOL) in patients withConclusions -It is concluded that poor chronic obstructive pulmonary disease scores on the SGRQ, a QOL scale which (COPD) may predict clinical outcomes measures patient distress and coping, are and use of resources. This study examined associated with re-admission for COPD whether QOL scores could prospectively and use of resources such as nebulisers, predict re-admission for COPD or death independent of physiological measures of within 12 months of an original admission, disease severity. and whether QOL scores predicted home (Thorax 1997;52:67-71) nebuliser provision. Methods -The study was carried out in all acute medical wards of Aberdeen Royal Keywords: chronic obstructive pulmonary disease, hospital admission, quality of life.Infirmary, Woodend and City Hospitals, Aberdeen over 12 months. A total of 377 patients admitted with an exacerbation of COPD were identified in this time, 111 Quality of life (QOL) scales assess the impact of whom were not included in the study of illness and experience of health among inbecause they refused the interview or died dividuals. These scales include general "well before discharge. The remaining 266 being" measures such as the Sickness Impact patients completed the St George's Res-Profile (SIP) 1 and the General Health Survey piratory Questionnaire (SGRQ). In-(SF-36) 2 and measures especially designed for formation on spirometric parameters, respiratory disease such as the Chronic Resnebuliser provision at discharge, provision piratory Questionnaire (CRQ) 3 and the St of domiciliary oxygen, and re-admission George's Respiratory Questionnaire (SGRQ). patient's experience of symptoms, how far Results -The mean age of the patients was symptoms such as breathlessness limit daily life 68 years and 53% were men. The mean activity, and how much distress the disease (SD) forced expiratory volume in one sec-causes the patient.5 6 Jones et al 7 argue that ond (FEV 1 ) was 38.8 (18.0)% predicted and QOL measures are particularly relevant to the forced vital capacity (FVC) was 58.9 management of patients with chronic ob-(23.8)% predicted. Higher (worse) scores structive pulmonary disease (COPD) because on the SGRQ were significantly related to much of this care is palliative and directed to re-admission for COPD in the next 12 improving patients' experience of health and months (difference=4.8, 95% CI 1.6 to well being. 8.0). Patients who were re-admitted andStudies have found that QOL of patients died from COPD did not differ in SGRQ with COPD improves after intervention such scores from those who were re-admitted as taking part in pulmonary rehabilitation proand survived for more than 12 months. grammes. [8][9][10] However, improvement in QOL Re-admission was not related to sex, age, does not correlate very strongly with changes SGRQ subscales (Symptom, Impact and who used more acute serv...

The outcome after 25 yr was studied for three groups of children classified in a random community survey in 1964 as having asthma (121 subjects), wheeze in the presence of infection (167 subjects), or no respiratory symptoms (167 comparison subjects). Approximately 80% of the subjects in each group, now aged 34 to 40 yr, were successfully traced. Current symptoms and smoking habit were recorded by questionnaire, and ventilatory function, peak flow variability, and bronchial reactivity to inhaled methacholine were measured. Subjects who had asthma in childhood were more likely to wheeze (odds ratio [OR] 14.4) or produce phlegm (OR 3.3) than comparison subjects. They also had significantly lower FEV1 values and greater bronchial reactivity than comparison subjects. Adult FEV1 correlated with childhood FEV1 (both expressed as % of predicted) (r = 0.44, p < 0.01). The prognosis for those children who were classed as having wheeze in the presence of infection in 1964 was better than for those who had asthma. Although they also were more likely to report wheeze (OR 3.8) or phlegm (OR 4.4) than comparison subjects, the wheezy symptoms were unlikely to interfere with activities and the ventilatory function and bronchial reactivity to methacholine did not differ from those of comparison subjects. Smokers were more likely to report wheeze (OR 2.0), cough (OR 7.2), and phlegm (OR 3.1) than never-smokers, and current smokers with current wheezy symptoms had significantly reduced FEV1 values, although smoking was not associated with increased methacholine reactivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Background-Quality of life measures are increasingly important in evaluating outcomes in asthma. If some asthma symptoms are more troublesome to patients than others, this may aVect their contribution to outcome measures. This study was designed to assess the relative importance of common symptoms in adults with asthma. Methods-A postal survey using conjoint analysis was performed in 272 adults attending hospital outpatient clinics with moderately severe asthma. Patients were asked to chose between "symptom scenarios" oVering diVerent combinations of levels of five common asthma symptoms over one week. Two versions of the questionnaire were used with identical scenarios presenting symptoms in diVerent orders. DiVerent patients answered the two versions. Regression analysis was used to calculate symptom weights for daytime cough, breathlessness, wheeze and chest tightness, and sleep disturbance. Results-Symptom order, percentage predicted peak expiratory flow (PEF), and symptoms in the week before the survey did not influence the choice of scenario. In both questionnaires patients were more likely to choose scenarios with low levels of cough and breathlessness than low sleep disturbance, wheeze or chest tightness. Regression weights for cough (-0.52) and breathlessness (-0.49) were twice those of wheeze (-0.25), chest tightness (-0.27), and sleep disturbance (-0.25). For 12% of patients cough dominated patient preferences, regardless of all other symptoms. Age was inversely related to weight given by patients to breathlessness. Conclusions-The prominence of cough among other asthma symptoms was unexpected. Daytime cough and breathlessness had greater impact for patients than wheeze or sleep disturbance. Age influenced symptom burden, with younger patients giving greater weight to breathlessness than older patients. Conjoint analysis appears to be a useful method for establishing the relative importance of common symptoms.

Background: There is still debate over the benefit of self-management programmes for adults with asthma. A brief self-management programme given during a hospital admission for acute asthma was tested to determine whether it would reduce readmission. Method: A randomised controlled trial was performed in 280 adult patients with acute asthma admitted over 29 months. Patients on the self-management programme (SMP) received 40-60 minutes of education supporting a written self-management plan. Control patients received standard care (SC). Results: One month after discharge SMP patients were more likely than SC patients to report no daytime wheeze (OR 2.6, 95% CI 1.5 to 5.3), no night disturbance (OR 2.0, 95% CI 1.2 to 3.5), and no activity limitation (OR 1.5, 95% CI 0.9 to 2.7). Over 12 months 17% of SMP patients were re-admitted compared with 27% of SC patients (OR 0.5, 95% CI 0.3 to 1.0). Among first admission patients, OR readmission (SMP v SC) was 0.2 (95% CI 0.1 to 0.7), p<0.01. For patients with a previous admission, OR readmission was 0.8 (95% CI 0.4 to 1.6), p=0.6. SMP patients were more likely than SC patients to be prescribed inhaled steroids at discharge (99% v 92%, p=0.03), oral steroids (98% v 90%, p=0.06), and to have hospital follow up (98% v 84%, p<0.01) but adjustment for these differences did not diminish the effect of the self-management programme. Conclusions: A brief self-management programme during hospital admission reduced post discharge morbidity and readmission for adult asthma patients. The benefit of the programme may have been greater for patients admitted for the first time. The programme also had a small but significant effect on medical management at discharge.