Health-related quality of life and chronic obstructive pulmonary disease in early stages – longitudinal results from the population-based KORA cohort in a working age population

Abstract

BackgroundIt is widely recognized that health-related quality of life (HRQL) is impaired in patients with Chronic Obstructive Pulmonary Disease (COPD), but there is a lack of research on longitudinal associations of COPD and HRQL. This study examined the effects of COPD in early stages of disease on HRQL over ten years in a working-age general population setting in Southern Germany while considering the influence of common comorbidities.MethodsIn the population-based KORA F4 study (2006–08) 1,321 participants aged 41–61 years performed spirometry and reported information on HRQL (measured by the generic SF-12) and comorbidities. For the same participants, HRQL information was available seven years before and three years after the lung function test from the previous S4 (1999–2001) and the F4L follow-up study (2010). Using linear mixed models, the physical and mental component summary scores (PCS-12 / MCS-12) of the SF-12 were compared over time between COPD groups.Results7.8% of participants were classified as having COPD (according to the LLN definition and the Global Lungs Initiative), 59.4% of them in grade 1. Regression models showed a negative cross-sectional association of COPD grade 2+ with PCS-12 which persisted when comorbidities were considered. Adjusted mean PCS-12 scores for the COPD grade 2+ group were reduced (−3.5 (p = 0.008) in F4, −3.3 (p = 0.014) in S4 and −4.7 (p = 0.003) in F4L) compared to the group without airflow limitation. The size of the COPD effect in grade 2+ was similar to the effect of myocardial infarction and cancer. Over ten years, a small decline in PCS-12 was observed in all groups. This decline was larger in participants with COPD grade 2+, but insignificant. Regarding MCS-12, no significant cross-sectional or longitudinal associations with COPD were found.ConclusionDespite small HRQL differences between COPD patients in early disease stages and controls and small changes over ten years, our results indicate that it is important to prevent subjects with airflow limitation from progression to higher grades. Awareness of HRQL impairments in early stages is important for offering early interventions in order to maintain high HRQL in COPD patients.

Association of generic health-related quality of life (EQ-5D dimensions) and inactivity with lung function in lung-healthy German adults: results from the KORA studies F4L and Age

“…296 Corresponding results were shown among subjects with COPD, where impairments of 297 respiratory function are reflected by the increasing GOLD grades 1-4. While subjects with 298 COPD grade 1 presented no significant effects for the mental or physical score obtained by 299 the SF-12 in comparison to healthy controls of the KORA F4 study, subjects with higher 300 grades of COPD showed a lower physical functioning score, but no associations with the 301 mental component [17]. Further, in a population-based survey across 17 countries lower 302 physical and mental scores were found in subjects with COPD in comparison to those 303 without COPD; confirming stronger effects for the physical than for the mental score [3].…”

“…57 To our knowledge, no study so far has examined the relationship between the EuroQol 5 58 dimensions (EQ-5D) questionnaire as a generic health-related quality of life instrument, and 59 lung function in a lung-healthy, population-based cohort with a comprehensive set of 60 spirometric measures. 61 The EQ-5D has been widely used to assess or compare health status across different 62 populations [2,[15][16][17][18][19]. It covers five dimensions of health: mobility, self-care, usual 63 activities, pain/discomfort, and anxiety/depression.…”

Perceived Satisfaction With Long-Term Oxygen Delivery Devices Affects Perceived Mobility and Quality of Life of Oxygen-Dependent Individuals With COPD

“…[6][7][8] However, because of the heterogeneity of COPD and the comorbid conditions that are often associated with it, researchers and practitioners have begun to use generic HRQOL measures in conjunction with disease-specific measures to evaluate outcomes of various interventions. [9][10][11][12] For example, Engström et al 13 argued that disease-specific HRQOL measures were not sufficient to examine the effect of COPD on life functions due to comorbidities frequently seen in the COPD population. In a study that assessed the HRQOL in individuals with varying severity of COPD, the researchers found that disease-specific HRQOL indicators correlated well with measures of lung function, but generic HRQOL indicators that measure emotional status and psychosocial function correlated poorly with measures of lung function.…”

Factors associated with generic health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD): a cross-sectional study

“…Previous studies considered factors such as age, sex and co-morbidity (14,16) and revealed conflicting results (7). For instance, one study performed in the Netherlands found a higher age as a negative predicting factor for the health status of COPD patients (8) while another study from the USA found that younger patients had worse health status (17).…”

“…Compared to healthy persons, previous studies showed a significantly lower physical and mental HRQOL in patients with COPD (13,14). Therefore, one aim in the German guidelines for diagnosis and therapy of COPD is the improvement of both health status and QOL (15).…”