Predictors of health status do not change over three-year periods and exacerbation makes difference in chronic obstructive pulmonary disease

Abstract

BackgroundThe association between disease markers and health status (HS) overtime is unclear. The aim of this study was to verify the predictors of HS at baseline and after three years in Chronic Obstructive Pulmonary Disease (COPD) patients.MethodsNinety-five consecutive COPD patients (66% male, age = 67 ± 9 y, FEV1 = 58 ± 23%) underwent the following evaluations at baseline and after three years: body composition, pulse oximetry (SpO2), six-minute walk distance (6MWD), Modified edical Research Council dyspnea scale (MMRC) and Saint George's Respiratory Questionnaire (SGRQ). The Charlson comorbidity index and BODE index were calculated. COPD exacerbations during the follow-up were evaluated. At baseline, age, gender, smoking, SpO2, BODE index or its components (BMI, MMRC, FEV1 and 6MWD), and Charlson index were included in a multiple linear regression analysis with the baseline SGRQ total score as the dependent variable. After three years, we included the final values of the variables plus the number of exacerbations and the final SGRQ total score as the dependent variable.ResultsSGRQ total score (42 ± 19% vs 44 ± 19%; p = 0.041) and activity domain (52 ± 21% vs 60 ± 22%; p < 0.001) deteriorated during follow-up. At baseline, BODE index was selected as a predictor of SGRQ total score (R2 = 0.46; p < 0.001); after three years, BODE index and age were the predictors (R2 = 0.49; p < 0.001). When the BODE index was replaced by its variables, MMRC was selected as the only variable associated with the SGRQ total score (R2 = 0.58; p < 0.001). After three years, MMRC, FEV1 and number of exacerbations were selected as predictors of SGRQ total score (R2 = 0.63; p < 0.001).ConclusionHS deteriorated significantly over the three-year period and the predictors of HS do not change over time. BODE index and dyspnea were predictors at baseline and after three years. Exacerbation was also a predictor of HS after three years.Trial RegistrationClinicalTrials.gov: NCT00605540

Change in health status in COPD: a seven-year follow-up cohort study

“…The DOSE (dyspnoea, obstruction, smoking, exacerbation) index 16 was found to predict changes in CCQ in a 2-year follow-up period, 17 and the BODE (BMI, obstruction, dyspnoea, exercise capacity) index 18 predicted change in SGRQ in a 3-year follow-up period. 19 In the latter study, the composite BODE index was also replaced by the included mono-components, with the result that dyspnoea and exacerbations but not BMI predicted change in health status. 19 …”

“… 19 In the latter study, the composite BODE index was also replaced by the included mono-components, with the result that dyspnoea and exacerbations but not BMI predicted change in health status. 19 …”

Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease

“…Patients completed the questionnaires themselves, assisted by the researchers only when needed; support was strictly limited to reading out the questions. SGRQ has been used as the gold standard for measurement of health status in clinical studies and exacerbation of COPD 5,30–32. However, exacerbation studies have assessed differences in health status over longer periods, from 1–6 months to 3 years 5,7,30,31.…”

“…SGRQ has been used as the gold standard for measurement of health status in clinical studies and exacerbation of COPD 5,30–32. However, exacerbation studies have assessed differences in health status over longer periods, from 1–6 months to 3 years 5,7,30,31. However, the length and complex scoring algorithm required for the SGRQ makes it less feasible in routine daily practice.…”

Determinants of 1‐year changes in disease‐specific health status in patients with advanced chronic obstructive pulmonary disease: A 1‐year observational study

“…Additionally, patient characteristics cannot be compared directly due to different stratifications of the study population: Habraken et al 5 distributed their population into three equal-sized groups stratified by change in SGRQ total score, whereas we used the MCID as a cutoff point to identify clinically relevant changes. Ferrari et al 32 studied changes in health status in patients with mild to severe COPD and reported that disease-specific health status as assessed by SGRQ worsened (≥ 4%) in 51% of the patients and improved in 28% of the patients.…”