CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study

M Miravitlles¹, M Ferrer², À Pont², R Zalacain³, J L Alvarez-Sala⁴, F Masa⁵, H Verea⁶, C Murio⁷, F Ros⁸, R Vidal⁹ for the IMPAC Study Group^*

¹ Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clinic, Barcelona, Spain
² Health Services Research Unit, Institut Municipal d’Investigació Mèdica, Barcelona, Spain
³ Unidad de Patología Respiratoria, Hospital de Cruces, Baracaldo (Vizcaya), Spain
⁴ Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain
⁵ Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
⁶ Servicio de Neumología, Hospital Juan Canalejo, La Coruña, Spain
⁷ Unitat de Pneumologia, Hospital General de Catalunya, Barcelona, Spain
⁸ R&D Department, QF Bayer, Barcelona, Spain
⁹ Servei de Pneumologia, Hospital General Vall d’Hebron, Barcelona, Spain

Correspondence to:
Correspondence to:
Dr M Miravitlles
Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain; marcm{at}clinic.ub.es

Background: A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD).

Methods: A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV₁) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George’s Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals.

Results: A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV₁ 35–50% predicted); the change in SGRQ total score of moderate patients with 3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV₁ <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001).

Conclusions: Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed.

Keywords: chronic obstructive pulmonary disease; quality of life; St George’s Respiratory Questionnaire; exacerbations

Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; HRQL, health related quality of life; SGRQ, St George’s Respiratory Questionnaire

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