Health-related quality of life associates with change in FEV1 in COPD: results from the COSYCONET cohort

Abstract

Background Forced expiratory volume in one second (FEV1) characterizes the pathophysiology of COPD and different trajectories of FEV1 decline have been observed in patients with COPD (e.g. gradual or episodic). There is limited information about the development of patient-reported health-related quality of life (HRQL) over the full range of the natural history of COPD. We examined the longitudinal association between change in FEV1 and change in disease-specific and generic HRQL. Methods We analysed data of 1734 patients with COPD participating in the COSYCONET cohort with up to 3 years of follow-up. Patients completed the Saint George’s Respiratory Questionnaire (SGRQ) and the EQ-5D Visual Analog Scale (EQ VAS). Change score models were used to investigate the relationship between HRQL and FEV1 and to calculate mean changes in HRQL per FEV1 change categories [decrease (≤ − 100 ml), no change, increase (≥ 100 ml)] after 3 years. Applying hierarchical linear models (HLM), we estimated the cross-sectional between-subject difference and the longitudinal within-subject change of HRQL as related to a FEV1 difference or change. Results We observed a statistically significant deterioration in SGRQ (total score + 1.3 units) after 3 years, which was completely driven by the activity component (+ 4 units). No significant change was found for the generic EQ VAS. Over the same period, 58% of patients experienced a decrease in FEV1, 28% were recorded as no change in FEV1, and 13% experienced an increase. The relationship between HRQL and FEV1 was found to be approximately linear with decrease in FEV1 being statistically significantly associated with a deterioration in SGRQ (+ 3.20 units). Increase in FEV1 was associated with improvements in SGRQ (− 3.81 units). The associations between change in FEV1 and the EQ VAS were similar. Results of the HLMs were consistent and highly statistically significant, indicating cross-sectional and longitudinal associations. The largest estimates were found for the association between FEV1 and the SGRQ activity domain. Conclusions Difference and change in FEV1 over time correlate with difference and change in disease-specific and generic HRQL. We conclude, that deterioration of HRQL should induce timely re-examination of physical status and lung function and possibly reassessment of therapeutic regimes. Trial registration NCT01245933. Date of registration: 18 November 2010.

Impact of Lung Function and Exacerbations on Health-Related Quality of Life in COPD Patients Within One Year: Real-World Analysis Based on Claims Data

“…We are the first to analyze the HRQoL changes in VAS and CAT with regard to changes in FEV 1 or exacerbations, stratified by GOLD ABCD groups and based on a large claims dataset. Similar to Lutter et al, 16 who evaluated the relationship of FEV 1 change and HRQoL change in GOLD groups I-IV within the German COSYCONET cohort, we did not find statistically significant changes in generic HRQoL for lung function declines. 16 These authors used the SGRQ to measure disease-specific HRQoL, which limits direct comparability to only generic results.…”

“…Similar to Lutter et al, 16 who evaluated the relationship of FEV 1 change and HRQoL change in GOLD groups I-IV within the German COSYCONET cohort, we did not find statistically significant changes in generic HRQoL for lung function declines. 16 These authors used the SGRQ to measure disease-specific HRQoL, which limits direct comparability to only generic results. Nonetheless, we also found a statistically significant deterioration in disease-specific CAT for the total sample and groups AB, which did not exceed the MID.…”

“…An overall deterioration in HRQoL at the population level is well known for other disease-specific and generic measures. 16,42,43 In our sample, HRQoL was highest in group A, followed in descending order by groups C, B, and D. This signals a better health status in C over B, even though group C faces a higher exacerbation burden. This is in line with the literature.…”

“…14 This decline in FEV 1 in COPD is associated with a decline in patients' HRQoL. [16][17][18] On the other hand, exacerbations also negatively affect HRQoL. [19][20][21][22] Nonetheless, the longitudinal association between these two clinical factors and HRQoL is not fully understood, [23][24][25] especially with regard to GOLD ABCD groups.…”

Discharge Plan to Promote Patient Safety and Shared Decision by a Multidisciplinary Team of Healthcare Professionals in a Respiratory Unit

“…Mary was also trained in measuring her FEV1 value at home. The value of FEV1 over time can show a rapid decline in lung function in COPD patients [36,37]. Any sign of deterioration was passed on to the medical team.…”