of Chronic Obstructive Pulmonary Disease and Quality of Life of Patients

 

GOLD 1

GOLD 2

GOLD 3

GOLD 4

Symptoms

46.9 ± 19.6

51.9 ± 21.7

58.1 ± 18.5**

66.2 ± 23.7***

Activity

47.4 ± 25.8

60.1 ± 20.3

67.9 ± 19.1***

80.7 ± 13.1***

Impact

25.9 ± 16.4

34.4 ± 17.1*

43.0 ± 19.0***

57.4 ± 16.3***

Total

36.6 ± 1.4

45.1 ± 15.7*

52.9 ± 16.1***

66.2 ± 13.1***


Symptoms: **p ≤ 0.01 for GOLD 3 vs. GOLD 2, and ***p ≤ 0.001 for GOLD 4 vs. GOLD 3

Activity: ***p ≤ 0.001 for both GOLD 3 vs. GOLD 2 and GOLD 4 vs. GOLD 3

Impact: *p ≤ 0.05 for GOLD 2 vs. GOLD 1, and ***p ≤ 0.001 for GOLD 3 vs. GOLD 2 and GOLD 4 vs. GOLD 3

Total: *p ≤ 0.05 for GOLD 2 vs. GOLD 1, and ***p ≤ 0.001 for GOLD 3 vs. GOLD 2 and GOLD 4 vs. GOLD 3



We did not show any correlations between the number of exacerbations, on the one side, and the individual components of the St. George’s Respiratory Questionnaire and pulmonary function tests, on the other side, in the patients at GOLD 1 and GOLD 4 stages. However we did find a number of correlations in the patients at GOLD 2 and GOLD s stages. In GOLD 2, the number of exacerbations correlated with symptoms (r = 0.33; p < 0.0001), impact of the disease on functional status (r = 0.34; p < 0.0001), and health status total score (r = 0.32; p = 0.0002) in St. George’s Respiratory Questionnaire, and with pre-bronchodilator vital capacity (VC) (r = −0.31; p = 0.0001), post-bronchodilator VC (r = −0.28; p = 0.0006), pre-bronchodilator forced expiratory volume in 1 s (FEV1) (r = −0.2; p = 0.01), and post-bronchodilator FEV1 (r = −0.22; p = 0.004) in pulmonary function tests. In GOLD 3, the number of exacerbations correlated with symptoms (r = 0.24; p = 0.01), activity (r = 0.32; p = 0.008), impact of the disease on functional status (r = 0.21; p = 0.03), and health status total score (r = 0.26; p = 0.0007) in St. George’s Respiratory Questionnaire as well as with the mMRC score (r = 0.21; p = 0.03).

An additional analysis was performed for patients with 0–1 exacerbation (n = 190; 72.8 %) and ≥2 exacerbations per year (n = 71; 27.2 %). The mean age was comparable in both groups. There were more women than men among those with ≥2 exacerbations per year (35.3 vs. 23.3 %, respectively; p <0.05). The mean FEV1 was lower in those with ≥2 exacerbations than with 0–1 exacerbations per year (1.2 ± 0.5 L vs. 1.5 ± 0.6 L; p < 0.01; 46.3 ± 16.7 % predicted vs. 53.1 ± 18.5 % predicted; p < 0.01, respectively) (Table 2). No differences were found in the number of hospitalizations. There were more patients treated with inhaled steroids and theophylline in the group with ≥2 exacerbations per year. These patients also had higher scores in the quality of life domains in the St. George’s Respiratory Questionnaire (Table 3).


Table 2
Comparison of post-bronchodilator spirometry in patients with 0–1 exacerbations and ≥2 exacerbations per year


































Exacerbations

0–1/year

≥2/year

p

FEV1 (L)

1.5 ± 0.6

1.2 ± 0.5

<0.01

FEV1 (% pred)

53.1 ± 18.5

46.3 ± 16.7

<0.01

FVC (L)

2.9 ± 0.9

2.5 ± 0.9

<0.01

FVC (% pred)

81.0 ± 21.5

73.2 ± 2.2

<0.01


FEV 1 forced expiratory volume in 1 s; forced vital capacity



Table 3
St. George’s Respiratory Questionnaire score in patients with 0–1 exacerbations and ≥2 exacerbations per year


































Exacerbations

0–1/year

≥2/year

p

Symptoms

49.4 ± 20.4

61.2 ± 25.2

<0.001

Activity

61.7 ± 21.2

75.9 ± 17.1

<0.001

Impact

35.8 ± 18.3

53.2 ± 17.3

<0.001

Total

46.1 ± 18.8

61.6 ± 14.4

<0.001


Data are means ± SD

The number of self-reported exacerbations ranged from 0 to 8 per year. On Visit 1, 92 patients reported 1 exacerbation (62 % hospitalizations) and 5 patients reported 8 exacerbations (60 % hospitalizations). On Visit 2 after 12 months into the study, 73 patients reported 1 exacerbation (29 % hospitalization); the maximal number of 5 exacerbations was reported only by 1 patient (100 % hospitalizations). On Visit 3 after 24 months, 48 patients reported 1 exacerbation (35 % hospitalizations); the maximal number of 6 exacerbations was reported by 1 patient again (100 % hospitalizations). No significant differences in the quality of life score in the St. George’s Respiratory Questionnaire and the perception of dyspnea scale in the Medical Research Council Questionnaire were noted throughout the study period (Table 4).


Table 4
Results of St. George’s Respiratory Questionnaire and Medical Research Council (mMRC) scales at the study beginning (Visit 1), after 12 months (Visit 2) and 24 months (Visit 3)











































 
Symptoms

Activity

Impact

Total

mMRC

Visit 1

56.2 ± 21.7

66.0 ± 21.2

40.8 ± 19.8

51.0 ± 18.0

2.1 ± 1.1

Visit 2

58.6 ± 20.8

62.2 ± 2.6

39.6 ± 20.5

49.8 ± 18.6

2.0 ± 1.0

Visit 3

58.1 ± 21.9

60.8 ± 19.6

39.5 ± 18.9

48.5 ± 17.2

2.1 ± 1.0

NS

NS

NS

NS
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Jul 2, 2016 | Posted by in RESPIRATORY | Comments Off on of Chronic Obstructive Pulmonary Disease and Quality of Life of Patients

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