Age-Related Differences in Health-Related Quality of Life in COPD

Martínez, Carlos H.; Díaz, Alejandro A.; Parulekar, Amit; Rennard, Stephen I.; Kanner, Richard E.; Hansel, Nadia N.; Couper, David J.; Holm, Kristen E.; Hoth, Karin F.; Curtis, Jeffrey L.; Martínez, Fernando J.; Hanania, Nicola A.; Regan, Elizabeth A.; Paine, Robert; Cigolle, Christine T.; Han, MeiLan K.

doi:10.1016/j.chest.2015.11.025

Cited by 44 publications

(26 citation statements)

References 38 publications

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“…However, significant interactions between COPD grades and comorbidities were not found. Notably, the HRQL gap between COPD patients and control subjects was larger in younger than in older age groups, which could be explained by a higher impact of dyspnea on HRQL [ 29 ]. As an individualized, patient-centered approach is postulated as the ideal care of COPD patients [ 30 ], younger patients with COPD may be an important target group for specific disease management.…”

Section: Discussionmentioning

confidence: 99%

Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies

Wacker¹,

Jörres

Karch

et al. 2016

Respir Res

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BackgroundHealth-related quality of life (HRQL) is an important patient-reported outcome measure used to describe the burden of chronic obstructive pulmonary disease (COPD) which is often accompanied by comorbid conditions.MethodsData from 2275 participants in the COPD cohort COSYCONET and from 4505 lung-healthy control subjects from the population-based KORA and SHIP studies were pooled. Main outcomes were the five dimensions of the generic EQ-5D-3 L questionnaire and two EQ-5D index scores using a tariff based on valuations from the general population and an experience-based tariff.The association of COPD in GOLD grades 1–4 and of several comorbid conditions with the EQ-5D index scores was quantified by multiple linear regression models while adjusting for age, sex, education, body mass index (BMI), and smoking status.ResultsFor all dimensions of the EQ-5D, the proportion of participants reporting problems was higher in the COPD group than in control subjects. COPD was associated with significant reductions in the EQ-5D index scores (-0.05 points for COPD grades 1/2, -0.09 for COPD grade 3, -0.18 for COPD grade 4 according to the preference-based utility tariff, all p < 0.0001). Adjusted mean index scores were 0.89 in control subjects and 0.85, 0.84, 0.81, and 0.72 in COPD grades 1-4 according to the preference-based utility tariff and 0.76, 0.71, 0.68, 0.64, and 0.58 for control subjects and COPD grades 1-4 for the experience-based tariff respectively. Comorbidities had additive negative effects on the index scores; the effect sizes for comorbidities were comparable to or smaller than the effects of COPD grade 3. No statistically significant interactions between COPD and comorbidities were observed. Score differences between COPD patients and control subjects were most pronounced in younger age groups.ConclusionsCompared with control subjects, the considerable reduction of HRQL in patients with COPD was mainly due to respiratory limitations, but observed comorbidities added linearly to this effect. Younger COPD patients showed a greater loss of HRQL and may therefore be in specific need of comprehensive disease management.Trial registrationNCT01245933

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Section: Discussionmentioning

confidence: 99%

Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies

Wacker¹,

Jörres

Karch

et al. 2016

Respir Res

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“…Martinez et al [23] demonstrated that older subjects with COPD report better HRQL than do younger COPD patients and that this age-related difference involves a lower impact of dyspnea with increasing age. Our data suggest that COPD is a major determinant factor for severe deterioration of HRQL leading to limitations of physical activity (good correlation between the 6MWD and FEV 1 : r = 0.6, p < 0.01) and of functional status in elderly patients with COPD, and that this influence largely depends on the severity of airway obstruction.…”

Section: Discussionmentioning

confidence: 99%

Predicting Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease: The Impact of Age

et al. 2016

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Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity in the elderly population. COPD leads to a reduced health-related quality of life (HRQL), but the factors which contribute to this are not well understood. A better understanding of the factors which determine HRQL should lead to an improved care for such patients. Objectives: The purpose of this study was to investigate possible age-related differences in HRQL in a population of patients with a similar severity of obstruction. Methods: A total of 180 consecutive COPD patients were enrolled into the study. We analyzed spirometric data, BODE index and its components, and comorbidities were assessed by the Charlson index. HRQL was assessed by the Clinical COPD Questionnaire (CCQ) and St. George's Respiratory Questionnaire (SGRQ). Results: The cohort consisted of 93 ‘younger' patients (mean age 54.8 ± 3.1 years) and 87 older patients (mean age 73.1 ± 5.5 years). Patients in both groups had a similar severity of obstruction: FEV₁ (% from predicted) was 39.9 ± 13.2% in the elderly group compared to 41.7 ± 11.7% in the younger group (p > 0.05). The forward stepwise regression analysis shows that the BODE index, the Charlson index, and the rate of exacerbations are important predictors of deterioration of HRQL in elderly COPD patients, which explains 29% of the total SGRQ score. In the younger COPD patients, the coefficient of determination R² was 0.27, but the predictors were the BODE index and the rate of exacerbations. Conclusions: The BODE index, the Charlson index, and the rate of exacerbations were found to be the major determinants of HRQL in elderly COPD patients, while in younger COPD patients, the BODE index and the rate of exacerbations were influential factors.

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“…Similarly, results from the Subpopulations and Intermediate Outcome Measures in COPD Study demonstrated that patients over age 65 years had better quality of life compared with patients age 50-64 years. 39 In addition, dyspnea was more strongly associated with QOL in the middle-aged patients. In assessing QOL in older people, there is not a clear relationship between disability, disease severity, and QOL.…”

Section: Discussionmentioning

confidence: 92%

Examining the Effects of Age on Health Outcomes of Chronic Obstructive Pulmonary Disease: Results From the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease Study and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate Endpoints Cohorts

Parulekar

Martínez

Tsai

et al. 2017

Journal of the American Medical Directors Association

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Rationale The prevalence of chronic obstructive pulmonary disease (COPD) and its associated comorbidities increase with age. However, little is understood about differences in the disease in patients over 65 years of age compared with younger patients. Objectives To determine disease characteristics of COPD and its impact in older patients compared with younger patients. Methods We examined baseline characteristics of patients with COPD (global obstructive lung disease stage II–IV) in 2 large cohorts: Genetic Epidemiology of COPD Study (COPDGene) and Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE). We compared demographics, indices of disease severity, prevalence of comorbidities, exacerbation frequency, and quality of life scores in patients ≥65 years of age vs patients <65 years of age. We also tested for associations of age with disease characteristics and health outcomes. Results In the COPDGene cohort, older patients (n = 1663) had more severe disease as measured by forced expiratory volume in 1 second (1.22 vs 1.52 L, P < .001), use of long-term oxygen therapy (35% vs 22%, P < .001), 6-minute walk distance (355 vs 375 m, P < .001), and radiographic evidence of emphysema (14% vs 8%, P < .001) and air trapping (47% vs 36%, P < .001) and were more likely to have comorbidities compared with younger patients (n = 2027). Similarly, in the ECLIPSE cohort, older patients (n = 1030) had lower forced expiratory volume in 1 second (1.22 vs 1.34 L, P < .001), greater use of long-term oxygen therapy (7% vs 5%, P = .02), shorter 6-minute walk distance (360 vs 389 m, P < .001), and more radiographic evidence of emphysema (17% vs 14%, P = .009) than younger patients (n = 1131). In adjusted analyses of both cohorts, older age was associated with decreased frequency of exacerbations [odds ratio = 0.52, 95% confidence interval (CI) 0.43-0.64 in COPDGene, odds ratio 0.79, 95% CI = 0.64-0.99 in ECLIPSE] and a better quality of life = (lower St. Georges respiratory questionnaire = score) (β = −8.7, 95% CI = −10.0 to −7.4 in COPDGene, β = −4.4, 95% CI = −6.1 to 3.2 in ECLIPSE). Conclusions Despite greater severity of illness, older patients with COPD had better quality of life and reported fewer exacerbations than younger patients. Although this observation needs to be explored further, it may be related to the fact that older patients change their expectations and learn to adapt to their disease.

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Age-Related Differences in Health-Related Quality of Life in COPD

Abstract: ClinicalTrials.gov; No.: NCT00608764 and No.: NCT01969344; URL: www.clinicaltrials.gov.

Cited by 44 publications

References 38 publications

Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies

Relative impact of COPD and comorbidities on generic health-related quality of life: a pooled analysis of the COSYCONET patient cohort and control subjects from the KORA and SHIP studies

Predicting Health-Related Quality of Life in Patients with Chronic Obstructive Pulmonary Disease: The Impact of Age

Examining the Effects of Age on Health Outcomes of Chronic Obstructive Pulmonary Disease: Results From the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease Study and Evaluation of Chronic Obstructive Pulmonary Disease Longitudinally to Identify Predictive Surrogate Endpoints Cohorts

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