Health-related quality of life in patients by COPD severity within primary care in Europe

Abstract

Pan-European data on health-related quality of life (HRQL) in chronic obstructive pulmonary disease (COPD) are lacking. This cross-sectional epidemiological study evaluated health status in 1817 COPD patients from an 'all-comers' primary care population in seven European countries (87% stable disease; 13% with current exacerbation) using: St George's Respiratory Questionnaire-COPD specific (SGRQ-C), the short form health survey (SF-12) and the Functional Assessment of Chronic Illness Therapy (FACIT) Fatigue scale. Mean total score for SGRQ was 44.7 ± 19.4 showing marked impairment of HRQL. Scores differed little between countries (range 39.2-50.1). Impairment was associated with the severity of airway obstruction, but within each GOLD stage the variation (SD) was wide [Stage I: 38.5 ± 19.3 (n = 223); Stage II: 40.4 ± 18.1 (n = 868); Stage III: 50.2 ± 18.6 (n = 551); Stage IV: 58.6 ± 17.7 (n = 144)]. Patients suffering an exacerbation had a worse SGRQ score (54.9 ± 19.3) than those with stable disease (43.3 ± 19.0). The presence of ≥3 co-morbidities (CM) was also associated with a significantly worse score (49.9 ± 19.1) vs. 1-2 CM (42.1 ± 19.1) or no CM (42.3 ± 18.6). Findings with the SF-12 and FACIT-F results were consistent with those from the SGRQ-C. This large observational primary care study shows that health status is significantly impaired in COPD patients of all severities, even in those with mild airway obstruction. Within each GOLD stage of severity there is considerable heterogeneity in HRQL impairment among patients. (Study number: 111749).

Patient-centred assessment of COPD in primary care: experience from a cross-sectional study of health-related quality of life in Europe

“…18,32 The wider PCP population reported here showed very similar baseline and demographic characteristics to patients fulfilling the stricter GOLD criteria described in the previous HRQL in Europe publication. 18 The characteristics of our population are in broad agreement with those reported in the EPIDEPOC study, a large observational study in primary care, specifically with respect to mean age, proportion of males/females, smoking history, associated co-morbidities, and mean…”

“…18 Descriptive statistics, analysed using Statistical Analysis Systems version 9.1.3 software (SAS Inc, Cary, USA), were used to report demographic and baseline characteristics and distribution of quality of life questionnaire scores for both the Health Outcomes Population (defined as all subjects who completed at least one questionnaire) and subgroups split by country, sex, age, COPD severity, COPD status (stable disease vs. exacerbation), COPD severity, and number of co-morbidities.…”

“…18 In brief, patients with PCP-diagnosed COPD attending a PCP for any reason were invited to participate in this cross-sectional single-visit observational study; patients were recruited between November 2008 and May 2009. This additional analysis evaluated patient data from five European countries (Belgium, France, Germany, the Netherlands, and Spain).…”

“…Results from this study for a population who fulfilled Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria have been published previously and demonstrated marked health status impairment in COPD patients of all severities, even those with mild disease. 18 The main aim of this paper is to describe the factors associated with the assessment by PCPs of COPD severity. The complete HEED population, who had a confirmed PCP diagnosis of COPD without applying strict spirometry criteria, was evaluated.…”

Benefits of Pulmonary Rehabilitation in Patients With COPD and Normal Exercise Capacity

“…14 The SGRQ is a questionnaire designed to measure the influence of chest diseases on HRQL. 14,23,24 The 50 items can be aggregated into an overall score and 3 subscores, for symptoms (8 items), activity (16 items), and impact (26 items). Responses are weighted and scores are calculated by dividing the summed weights by the maximum possible weight, 0 being the best possible score, and 100 the worst.…”