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Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study
  1. M Miravitlles1,
  2. M Ferrer2,
  3. À Pont2,
  4. R Zalacain3,
  5. J L Alvarez-Sala4,
  6. F Masa5,
  7. H Verea6,
  8. C Murio7,
  9. F Ros8,
  10. R Vidal9,
  11. for the IMPAC Study Group*
  1. 1Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clinic, Barcelona, Spain
  2. 2Health Services Research Unit, Institut Municipal d’Investigació Mèdica, Barcelona, Spain
  3. 3Unidad de Patología Respiratoria, Hospital de Cruces, Baracaldo (Vizcaya), Spain
  4. 4Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain
  5. 5Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, Spain
  6. 6Servicio de Neumología, Hospital Juan Canalejo, La Coruña, Spain
  7. 7Unitat de Pneumologia, Hospital General de Catalunya, Barcelona, Spain
  8. 8R&D Department, QF Bayer, Barcelona, Spain
  9. 9Servei de Pneumologia, Hospital General Vall d’Hebron, Barcelona, Spain
  1. Correspondence to:
    Dr M Miravitlles
    Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica, Hospital Clinic, Villarroel 170, 08036 Barcelona, Spain;


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.

  • chronic obstructive pulmonary disease
  • quality of life
  • St George’s Respiratory Questionnaire
  • exacerbations
  • 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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  • * Investigators participating in the IMPAC study are listed in the appendix.

  • The IMPAC Study was funded by an unrestricted grant from QF Bayer Spain.

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