The influence of COPD on health-related quality of life independent of the influence of comorbidity

doi:10.1016/S0895-4356(03)00208-7

Journal of Clinical Epidemiology

Volume 56, Issue 12, December 2003, Pages 1177-1184

https://doi.org/10.1016/S0895-4356(03)00208-7 Get rights and content

Abstract

Background and objective

The goal of this study was to determine the influence of chronic obstructive pulmonary disease (COPD) on health-related quality of life (HRQL) independent of comorbidity.

Methods

Patients with COPD in general practice, ⩾40 years, were selected. To recruit controls, a random sample of persons without COPD and ⩾40 years, was taken. HRQL was assessed with the SF-36 and comorbidity was determined by questionnaire.

Results

The influence of COPD on HRQL independent of comorbidity (represented by adjusted regression coefficients) was significant for physical functioning (−27.6), role functioning due to physical problems (−21.6), vitality (−14.4), and general health (−25.7), and was minor and not significant for social functioning (−5.6), mental health (−1.3), role functioning due to emotional problems (−2.7), and bodily pain (−2.5). Comorbidity contributed significantly to the HRQL of all domains (−7.6 to −27.1).

Conclusion

COPD patients can be impaired in all domains of HRQL. However, impairments in physical functioning, vitality, and general health are related to COPD and to some extent to comorbidity, while impairments in social and emotional functioning do not seem to be related to COPD, but only to comorbidity.

Introduction

Because pulmonary function is chronically and irreversibly impaired in chronic obstructive pulmonary disease (COPD) patients, it is widely recognized that the treatment of COPD patients should not be directed only towards pulmonary function. Additionally, the minimization of the patients' symptoms and the improvement of the ability to function in day-to-day life, or, in other words, the improvement of health-related quality of life (HRQL), are important therapeutic goals in COPD patients [1]. Knowledge about the HRQL impairments in COPD patients is needed, because this gives information on the specific problems that patients experience and may, therefore, guide treatment priorities and adequate care.

In studies that compared the HRQL of COPD patients to the HRQL of controls, patients and controls were often comparable with respect to age or gender [2], [3], [4], [5], [6], [7], [8], [9], [10]. However, the results were not adjusted for the presence of comorbidity, even though other chronic conditions frequently occur in COPD patients and also occur more often than in controls (general populations) [11].

Although it is apparent from previous studies that COPD patients have worse HRQL than controls, it is unclear whether the observed differences between COPD patients and controls can be attributed to the influence of COPD itself or to the influence of other chronic conditions. This is an important issue because if the impairments in COPD patients do not particularly appear to be the consequence of COPD itself, efforts to improve the HRQL in COPD patients should focus less on problems that are specifically associated with COPD, but should focus relatively more on problems that are associated with comorbidity. The aim of the present study was therefore to determine the influence of COPD on different aspects of HRQL independent of the influence of comorbidity and other prognostic variables.

Section snippets

Selection of COPD patients

A COPD patient was defined as a patient with an FEV1/VC-ratio before and after inhalation of 400 μg salbutamol below the reference ratio minus 1.64×standard deviation, an FEV1 <80% predicted, a reversibility in FEV1% pred ⩽12%, and a history of smoking. These patients were selected in 28 general practices from urban and suburban regions in the western part of The Netherlands, and selection was carried out in three consecutive steps [1]. Because spirometry is not always performed to

General characteristics

Of all COPD patients, 72% was suffering from comorbidity, and 63% of all controls had one or more chronic conditions (Table 1). COPD patients and controls with comorbidity were older (⩾60 years) than COPD patients and controls without comorbidity (81 and 76% vs. 66 and 59%). They also were less often men (68 and 42% vs. 73 and 43%), had more often a low education (86 and 83% vs. 82 and 70%), and lived more often alone (28 and 27% vs. 20 and 15%). In COPD patients 73% had one or two other

Discussion

The question of the present study was whether the impairments that are seen in COPD patients can indeed be attributed to COPD—which has been assumed so far—or to comorbid diseases that are very common in these patients. We found that the impairments in physical functioning, role functioning due to physical problems, vitalitym and general health are to a large extent related to COPD, but also to comorbidity. However, impairments in the HRQL domains social functioning, mental health, and role

Acknowledgements

This study was supported by Boehringer Ingelheim NL by supplying all materials and personnel for the lung function testing.

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The influence of COPD on health-related quality of life independent of the influence of comorbidity

Abstract

Background and objective

Methods

Results

Conclusion

Introduction

Section snippets

Selection of COPD patients

General characteristics

Discussion

Acknowledgements

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

Chest

Respir Med

Chest

Lancet

Pulmonary rehabilitation in chronic respiratory insufficiency. 7. Health-related quality of life among patients with chronic obstructive pulmonary disease

Thorax

Life quality of patients with chronic obstructive pulmonary disease

Arch Intern Med

Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease

Arch Intern Med