Original Article
Symptom Distress and Quality of Life in Patients with Advanced Chronic Obstructive Pulmonary Disease

https://doi.org/10.1016/j.jpainsymman.2008.07.006Get rights and content
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Abstract

Although chronic obstructive pulmonary disease (COPD) is a highly prevalent and disabling illness, few empirical studies have evaluated the impact of the disease on symptom distress, functional status, and quality of life. These outcomes were explored in a prospective survey of 100 patients with advanced COPD. Patients were recruited from two academic centers. The mean forced expiratory volume in 1 second (FEV1) was 24.4% (standard deviation = 3.9). Validated instruments were used to assess symptom distress (Memorial Symptom Assessment Scale [MSAS]), mental health (Mental Health Inventory [MHI]-5), functional status (Sickness Impact Profile [SIP]), quality of life (Multidimensional Index of Life Quality [MILQ]), spirituality (Functional Assessment of Chronic Illness Therapy [FACIT] Spirituality Scale), and comorbid conditions (Charlson Comorbidity Index). The most prevalent symptoms were dyspnea (94%), fatigue (71%), xerostomia (60%), coughing (56%), and anxiety (51%). Other symptoms with high prevalence were drowsiness (47%), irritability (42%), feeling nervous (40%), and wheezing (40%). Significant pain was reported in about one-third of patients. Patients reported relatively high levels of overall functional impairment (SIP median = 24.0) and modest impairment in overall quality of life (MILQ median = 52). Overall, psychological well-being was relatively unimpaired (median = 24.5), and the comfort derived from faith was intact (FACIT median = 2.5). Impairment in quality of life was strongly associated with symptom distress (MSAS-GDI; r = −0.74, P < 0.001), functional impairment (SIP total; r = −0.59, P < 0.001), female sex (r = −0.26, P = 0.01), and poor psychological well-being (MHI-5; r = 0.68, P < 0.001). In multivariate analyses, poor quality of life was strongly correlated with higher total symptom distress, sickness-related dysfunction, and lower levels of psychological well-being (R2 = 0.66). In addition, two specific psychological symptoms—worrying and feeling irritable—were independently predictive of poor quality of life. Patients with advanced COPD have multiple distressing symptoms and a high prevalence of disturbances in mood, functional status, and quality of life. A focus on ameliorating prevalent physical symptoms and psychological distress may lead to an improvement in the overall quality of life in this patient population.

Key Words

Chronic obstructive pulmonary disease
symptom distress
quality of life
MSAS

Cited by (0)

This study was supported by grant #NR05154 from the National Institute of Nursing Research, National Institutes of Health to Dr. Sharon Tennstedt.