Chronic obstructive pulmonary disease trajectory: severe exacerbations and dynamic change in health-related quality of life

Abstract

BackgroundThe life trajectory of chronic obstructive pulmonary disease (COPD) remains unknown.Patients and methodsWe collected data from two populations. In the first cohort, we recruited 375 patients with COPD from our hospital, and 1440 repeated assessments of quality of life (QoL) using the European Quality of Life-5 Dimensions questionnaire from 2006 to 2020. We analysed their dynamic changes using the kernel-smoothing method. The second cohort comprised 27 437 patients from the National Health Insurance (NHI) dataset with their first severe acute exacerbations (AEs) requiring hospitalisation from 2008 to 2017 were analysed for their long-term course of AEs. We employed a Cox hazard model to analyse the predictors for mortality or AEs.ResultsCohorts from our hospital and NHI were male predominant (93.6 and 83.5%, respectively). After the first severe AE, the course generally comprised three phases. The first was a 1-year period of elevated QoL, followed by a 2-year prolonged stable phase with a slowly declining QoL. After the second AE, the final phase was characterised by a rapid decline in QoL. For NHI cohort, 2712 died during the 11-year follow-up, the frequency of the first AE was approximately 5 per 10 000 per day. The median time from the first to the second AE was 3 years, which decreased to less than 6 and 3 months from 4th to 5th and 8th to 9th AE, respectively. The frequency of AE was increased 10-fold and 15-fold and risk of subsequent AE was increased 12-fold and 20-fold after the 6th and the 10th AE, relative to the first. Male gender, heart failure comorbidities were associated with the risk of subsequent AE and death.ConclusionsThe life trajectory of COPD includes the accelerated frailty phase, as well as elevated health and prolonged stable phase after the first AE.

Diagnostic Utility of Specific Frailty Questionnaire: The Kihon Checklist for Hippocampal Atrophy in COPD

“…Questions (16) and (17) aim to evaluate the seclusion domain, which addresses the aspects of social isolation [17]. The findings of this study highlight that lifestyle factors, as evaluated by items (1-5), (16)(17), and physical strength, as assessed through items (6)(7)(8)(9)(10), are associated with decreases in hippocampal volume. This association highlights the vulnerabilities linked to these subdomains, suggesting that lifestyle and physical health are significant factors in the structural integrity of the hippocampus, especially in populations at risk of or diagnosed with conditions such as COPD.…”

“…In this study, specific KCL subdomains that demonstrated the strongest correlation with hippocampal volume were identified through questions (1-5), (6)(7)(8)(9)(10), and (16)(17). The first five questions, designated as KCL (1)(2)(3)(4)(5), pertain to instrumental activities of daily living (IADL), assessing the ability to execute daily tasks that demand both cognitive and physical capabilities.…”

“…Notably, the scores from KCL (1-20) (left: ρ= −0.54, p < 0.0005, right: ρ = −0.48, p < 0.005) had a significantly greater impact on the overall KCL 1-25 scores than those from KCL (21-25) (left: ρ = −0.34, p < 0.05, right: ρ = −0.34, p < 0.05), particularly affecting the volume of the left hippocampus. Within the KCL (1-20) subset, scores for KCL (1-5), (6)(7)(8)(9)(10), and (16)(17) were identified as the primary contributors. As shown in Figure 5, the KCL subdomain scores of (1-25), (1-20), (1-5), (6-10), and (16-17) were validated as effective clinical instruments for identifying COPD patients whose left hippocampal volume falls in the lowest quartile.…”

“…Each subdomain reached an area under the curve (AUC) of 0.78, indicating reliability. Specifically, achieving a score of 13 or higher or a score of 6 or higher in the KCL overall domain (1-25) and the KCL sub-domain (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), respectively, resulted in a specificity of 93% and a sensitivity of 90%. In the KCL subdomains (1-5) and (6-10), a score of 2 or higher or a score of 3 or more, respectively, resulted in a sensitivity of 80% and a specificity of 87%, and a score of 1 or higher in the KCL subdomain (16)(17) attained 83% specificity in detecting individuals within the lowest quartile.…”

“…Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and deteriorating health, often accompanied by various extrapulmonary manifestations such as physical inactivity, sarcopenia, nutritional disorders, and cardiovascular disease [ 1 , 2 , 3 , 4 , 5 ]. These comorbidities exacerbate the overall health burden of COPD [ 6 , 7 , 8 , 9 ]. Additionally, this clinical multisystem decline reflects an increased vulnerability to health deterioration known as frailty.…”