Quality of life and hospital re-admission in patients with chronic obstructive pulmonary disease

Abstract

Abstractnot differ from men in Symptom scores on the SGRQ but differed markedly on the Background -There is some evidence that Activity and Impact scales. quality of life (QOL) in patients withConclusions -It is concluded that poor chronic obstructive pulmonary disease scores on the SGRQ, a QOL scale which (COPD) may predict clinical outcomes measures patient distress and coping, are and use of resources. This study examined associated with re-admission for COPD whether QOL scores could prospectively and use of resources such as nebulisers, predict re-admission for COPD or death independent of physiological measures of within 12 months of an original admission, disease severity. and whether QOL scores predicted home (Thorax 1997;52:67-71) nebuliser provision. Methods -The study was carried out in all acute medical wards of Aberdeen Royal Keywords: chronic obstructive pulmonary disease, hospital admission, quality of life.Infirmary, Woodend and City Hospitals, Aberdeen over 12 months. A total of 377 patients admitted with an exacerbation of COPD were identified in this time, 111 Quality of life (QOL) scales assess the impact of whom were not included in the study of illness and experience of health among inbecause they refused the interview or died dividuals. These scales include general "well before discharge. The remaining 266 being" measures such as the Sickness Impact patients completed the St George's Res-Profile (SIP) 1 and the General Health Survey piratory Questionnaire (SGRQ). In-(SF-36) 2 and measures especially designed for formation on spirometric parameters, respiratory disease such as the Chronic Resnebuliser provision at discharge, provision piratory Questionnaire (CRQ) 3 and the St of domiciliary oxygen, and re-admission George's Respiratory Questionnaire (SGRQ). patient's experience of symptoms, how far Results -The mean age of the patients was symptoms such as breathlessness limit daily life 68 years and 53% were men. The mean activity, and how much distress the disease (SD) forced expiratory volume in one sec-causes the patient.5 6 Jones et al 7 argue that ond (FEV 1 ) was 38.8 (18.0)% predicted and QOL measures are particularly relevant to the forced vital capacity (FVC) was 58.9 management of patients with chronic ob-(23.8)% predicted. Higher (worse) scores structive pulmonary disease (COPD) because on the SGRQ were significantly related to much of this care is palliative and directed to re-admission for COPD in the next 12 improving patients' experience of health and months (difference=4.8, 95% CI 1.6 to well being. 8.0). Patients who were re-admitted andStudies have found that QOL of patients died from COPD did not differ in SGRQ with COPD improves after intervention such scores from those who were re-admitted as taking part in pulmonary rehabilitation proand survived for more than 12 months. grammes. [8][9][10] However, improvement in QOL Re-admission was not related to sex, age, does not correlate very strongly with changes SGRQ subscales (Symptom, Impact and who used more acute serv...

Patients hospitalized for COPD have a high prevalence of modifiable risk factors for exacerbation (EFRAM study)

“…A degree of nonresponse (selection) bias is probably present, although the participation rate was 82%, higher than in other studies on hospitalized COPD patients requested to answer a questionnaire [6,34]. The lower prevalence of coexisting chronic conditions in nonresponders could be explained by the fact that there was no data in the medical record about the milder diseases that were asked about in the questionnaire (e.g.…”

Gaps in the care of patients admitted to hospital with an exacerbation of chronic obstructive pulmonary disease

“…2,3 They also have high 1-year readmission and postdischarge mortality rates: 25%-59% [4][5][6] and 11%-22%, 7 respectively. Despite the heavy burden of COPD in acute care hospitals, few studies have explored the relation between quality of inpatient care for COPD and adverse events.…”

Self-management reduces both short- and long-term hospitalisation in COPD

“…COPD progresses through different stages, and has a major impact on functional abilities and quality of life [3][4][5]. The disease is also characterised by episodes of acute exacerbations that contribute to the deterioration of patients' health status [4,5].…”