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CHRONIC OBSTRUCTIVE PULMONARY DISEASE |
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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Thorax 2004 59: 361.
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