A study in the primary care setting shows that clinical factors have the greatest influence on improving health-related quality of life (HRQoL) in patients with chronic obstructive pulmonary disease (COPD).
The results, published in Respiratory Medicine, also highlight that, while overall change in HRQoL in the study population was minimal over the course of a year, individuals varied greatly in the way HRQoL changed over time.
The research team, led by Mònica Monteagudo (Universitat Autònoma de Barcelona, Spain), followed up 791 COPD patients who completed the St George’s Respiratory Questionnaire (SGRQ) at baseline and 1 year later.
They found that over the course of the year, mean SGRQ score fell from 37.1 to 35.6. However, while this was statistically significant, it was not clinically relevant, failing to change by more than 4 points.
Despite this minimal change in HRQoL overall, SGRQ remained static in only 34.1% of patients over the year; 36.7% had a significant improvement in HRQoL (>4-point decrease in SGRQ), and 29.2% a significant decrease (>4-point increase in SGRQ).
The researchers identified distinct characteristics of patients who had improved or worsened HRQoL. Those who began visiting a pulmonologist, began polymedication, or reported embarking on a balanced diet were threefold more likely to experience a 4-point decrease in SGRQ score, after accounting for confounders, while quitting smoking was associated with a nearly fivefold increased odds for HRQoL improvement. Additionally, not having frequent exacerbations, having a lower degree of dyspnea, and completing rehabilitation were associated with improved HRQoL.
Factors independently associated with worsened HRQoL included an increase in symptoms of expectoration and dyspnea, and being admitted to hospital, leading to a 2.8-, 1.3-, and 3.3-fold increased odds for an SGRQ score increase of at least 4 points, respectively.
Monteagudo and colleagues say that their findings contrast with those reported to date in hospital-based settings, which have found clinically relevant deterioration in global HRQoL over follow-up.
“Given the differences in patient characteristics and disease status, the results obtained in hospital populations may not be generalizable to patients in primary care,” they comment.
Hospital-admitted patients probably have “more serious health problems, more comorbidities, and worse baseline HRQoL, which could lead to more rapid decline in HRQoL,” they add.
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