Functional Status and Quality of Life in Chronic Obstructive Pulmonary Disease

https://doi.org/10.1016/j.amjmed.2006.08.005Get rights and content

Abstract

Exertional dyspnea often causes patients with chronic obstructive pulmonary disease (COPD) to unconsciously reduce their activities of daily living (ADLs) to reduce the intensity of their distress. The reduction in ADLs leads to deconditioning which, in turn, further increases dyspnea. Both dyspnea and fatigue are important factors affecting health-related quality of life (HRQOL). The functional status of patients relates to how well they perform ADLs. Activities, however, may not be severely limited until the disease becomes advanced. The elimination of an ADL depends on the necessity or desirability of that activity and the intensity of the associated symptoms. HRQOL is measured using symptoms, functional status, and a rating of their impact on the individual. The Pulmonary Functional Status Scale (PFSS) and the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ) are 2 COPD-specific functional status questionnaires. Pedometers or accelerometers can quantify the levels of activity of patients with COPD. HRQOL is measured with validated multidimensional questionnaires that cover symptoms, physical, psychological, and social domains. Ideally, these instruments are discriminative (i.e., separate degrees of impairment) and evaluative (i.e., detect small changes after therapy). HRQOL questionnaires may be generic (e.g., Medical Outcomes Study Short Form-36 [SF-36]) and can measure favorable changes after intervention, such as pulmonary rehabilitation, or they can be disease specific with disease-related domains, e.g., Chronic Respiratory Disease Questionnaire (CRQ) with domains of dyspnea, fatigue, emotion, and mastery; and St. George’s Respiratory Questionnaire (SGRQ) with domains of symptoms, activity, and psychosocial impact. A case is presented that depicts how these tools may be used to evaluate improvement with intervention in a patient with COPD.

Section snippets

Definitions and concepts of functional status and health-related quality of life

“Functional status” is a term often used to refer to the level of involvement in activities and is often synonymous with the performance of ADLs. Functional status has also been used to describe other elements of function, such as physiologic (spirometry), exercise (walk tests), psychologic, or social function. For our discussion, functional status will be used to refer to participation in ADLs.1 QOL has been defined as “a holistic, self-determined evaluation of satisfaction with issues

Methods of functional status assessment in chronic obstructive pulmonary disease

Functional status, or activity limitation, in COPD is most commonly assessed in clinical research with self-report questionnaires or by monitoring activity with devices such as pedometers or triaxial accelerometers.

The Pulmonary Functional Status Scale (PFSS)11 and the long and short version of the Pulmonary Functional Status and Dyspnea Questionnaire (PFSDQ)12 are 2 COPD-specific functional status questionnaires. The functional activities domain of the PFSS includes subscores for self-care,

Methods of health-related quality of life measurement in chronic obstructive pulmonary disease

HRQOL can be measured using standardized and validated questionnaires that address common issues experienced by patients. Most HRQOL questionnaires are multidimensional, often covering symptom, physical, psychologic, and social domains. The ideal instrument should be both discriminative—able to separate individuals with differing degrees of impairment—and evaluative—able to detect small changes following therapy or over time. HRQOL assessment provides an estimate of the global effect of a

Case study

The following case is included to underscore the value of assessing respiratory symptoms (e.g., dyspnea), functional status, and HRQOL in the workup of COPD. Additionally, it will serve to highlight how these important health variables may show change after a strong therapeutic intervention, pulmonary rehabilitation.

A 65-year-old man was referred to outpatient pulmonary rehabilitation because of persistent exertional dyspnea despite optimized pharmacologic therapy. He had a history of asthma in

Summary

Symptoms and functional status limitations are major contributors to HRQOL in COPD. Assessment in these areas using standardized questionnaires in clinical trials is useful in determining the overall effectiveness of a particular intervention. The usefulness of questionnaires in the clinical setting remains to be determined and their routine use is often impractical. However, the one-on-one clinical evaluation should (and often does) informally incorporate elements of symptom evaluation,

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