Greater dyspnea is associated with lower health-related quality of life among European patients with COPD

Abstract

ObjectiveDyspnea is a defining symptom in the classification and treatment of chronic obstructive pulmonary disease (COPD). However, the degree of variation in burden among symptomatic COPD patients and the possible correlates of burden remain unclear. This study was conducted to characterize patients in Europe currently being treated for COPD according to the level of dyspnea in terms of sociodemographics, health-related quality of life, work productivity impairment, and health care resource use assessed by patient reports.MethodsData were derived from the 5-EU 2013 National Health and Wellness Survey (N=62,000). Respondents aged ≥40 years who reported currently using a prescription for COPD were grouped according to their level of dyspnea as per the Global Initiative for Chronic Obstructive Lung Disease guidelines and compared on health status (revised Short Form 36 [SF-36]v2), work impairment (Work Productivity and Activity Impairment questionnaire), and number of health care visits in the past 6 months using generalized linear models with appropriate distributions and link functions.ResultsOf the 768 respondents who met the inclusion criteria, 245 (32%) were considered to have higher dyspnea (equivalent to modified Medical Research Council score ≥2). Higher dyspnea was associated with decrements ranging from 3.9 to 8.2 points in all eight domains of the SF-36 health profile after adjustment for sociodemographics, general health characteristics, and length of COPD diagnosis; mental component summary scores and Short Form-6D health utility scores were lower by 3.5 and 0.06 points, respectively. Adjusted mean activity impairment (55% vs 37%, P<0.001) and number of emergency room visits (0.61 vs 0.40, P=0.030) were higher in patients with greater dyspnea.ConclusionMany European patients with COPD continue to experience dyspnea despite treatment and at levels associated with notable impairments in the patients’ ability to function across a multitude of domains. These patients may benefit from more intense treatment of their symptoms.

A systematic review of how patients value COPD outcomes

“…The estimates were based on a small sample, so we downgraded the certainty for the estimates by one level for level 2 and two levels for level 3 breathlessness due to concerns about imprecision. Two other reports corroborated that the more severe the dyspnoea symptom, the lower utility patients place on their health, though the specific levels of breathlessness were described differently (table 3) [43,49]. Other structured surveys, without reporting utility values, also suggested dyspnoea as burdensome and a very important consideration in COPD-related decision-making [31,[50][51][52][53][54][55][56][57][58].…”

A dose-ranging study of the inhaled dual phosphodiesterase 3 and 4 inhibitor ensifentrine in COPD

“…Inhaled long-acting bronchodilators and corticosteroids have been shown to improve symptoms and health-related quality of life, and to reduce exacerbation rates in patients with COPD [1]. However, many patients still experience daily symptoms [2][3][4], exacerbations [5][6][7], and accelerated lung function decline [8], even when receiving maximal combined treatment with these inhaled drugs. Novel treatment options are needed for these patients.…”

Russian guidelines for the management of COPD: algorithm of pharmacologic treatment

“…This decision was based on the higher efficacy of long-acting drugs 12 and the possibility of underrecognition or underreporting of symptoms in patients with COPD. 13 , 14 …”