Background The longitudinal change in quality of life (QoL) following hospitalisation for acute exacerbations of COPD (AECOPD) is uncertain. Current guidelines suggest that non-invasive ventilation (NIV) should not be considered if there is no “potential for recovery to QoL acceptable to the patient”, but the expected QoL recovery in this population has not been reported.
Methods 183 patients (82 treated with NIV) with AECOPD surviving to hospital discharge were identified prospectively. QoL questionnaires were completed at hospital discharge and at four predefined intervals during the year following discharge, however, for brevity, only the results of the St. George’s Respiratory Questionnaire (SGRQ) are reported. Baseline clinical information and subsequent mortality and readmission over 12 months were recorded. Longitudinal QoL was summarised by calculating the mean change in SGRQ (mean change < 0 indicates a QoL improvement during follow-up), with the minimal clinically important SGRQ change taken as ±4.
Results Mean (SD) age was 69.0 (9.0) years and most patients: were female (58.5%); had severe airflow obstruction (mean (SD) FEV1 40.2 (17.3) % predicted); and were of normal weight (mean (SD) BMI 26.2 (7.0) kgm2). The 12-month readmission and mortality rate were 71% and 18% respectively.
7 patients failed to attend follow-up after discharge and were excluded from analysis. For both patient groups, self-reported respiratory symptoms (SGRQ Symptoms) improved by a clinically important amount during follow-up. For the total population, average overall QoL (SGRQ total) improved during follow-up (mean (SD) change in SGRQ total = –2.47 (13.0)), but not by a clinically important amount. Patients not treated with NIV experienced both a clinically important QoL improvement and a significantly greater improvement than those treated with NIV. However, the average quality of life of those treated with NIV did not decline by a clinically important amount (table 1).
Conclusions On average, patients hospitalised with AECOPD not requiring NIV experience an improvement in QoL following discharge and in those treated with NIV, QoL does not appear to decline. Most patients can expect their quality of life to be no worse than that reported at hospital discharge.
BTS The Use of Non-Invasive Ventilation in the management of patients with chronic obstructive pulmonary disease admitted to hospital with acute type II respiratory failure, 2008.