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Reversible bronchial obstruction and disease-related health status in COPD

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Abstract

We aimed to assess whether partially reversible and fixed airway obstructions are associated with different health status profiles of chronic obstructive pulmonary disease (COPD) patients. We characterized health status profiles of outpatients over 64 years suffering from COPD with fixed (n = 181) or partially reversible obstruction (n = 95) and from chronic bronchitis with forced expiratory volume in the first second (FEV1) > 69% of that predicted (n = 109) on the basis of the Saint George Respiratory Questionnaire (SGRQ) and indexes assessing cognitive (Mini Mental State), affective (15-item Geriatric Depression Scale) and physical status (Index of Barthel, six-minute walking test) and quality of sleep (Index of disturbed sleep). The degree of group-specificity of health status profiles was assessed by discriminant analysis. The 54.1% of COPD patients with partially reversible obstruction were recognized to have a distinctive health status profile characterized by a moderate to severe impairment of all components (‘Symptoms’, ‘Activity’, ‘Impacts’) of the SGRQ and of select indexes of performance. According to logistic regression analysis, this health status profile was associated with FEV < 46% of that predicted (odds ratio (OR): 1.6, 95% confidence interval (CI): 1.07–2.38), the use of at least three respiratory drugs (OR: 2.28, CI: 1.46–3.57) and living alone (OR: 2.01, 95% CI: 1.3–2.29). COPD patients with fixed obstruction had a very heterogeneous health status. Research is needed to verify whether the unfavorable health status profile typical of a subset of COPD patients is associated with a distinctive prognosis and can be improved by dedicated therapeutic interventions.

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References

  1. Sestini P, Ram FS. Short-acting beta 2 agonists for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2000; 2: CD001495.

    Google Scholar 

  2. Postma DS, Gimeno F, van der Weele LT, Sluiter HJ. Assessment of ventilatory variables in survival prediction of patients with chronic airflow obstruction: The importance of reversibility. Eur J Respir Dis 1985; 67: 360-368.

    Google Scholar 

  3. Anthonisen NR, Wright EC, Hodgkin JE and the IPPB Trial Group. Prognosis in chronic obstructive pulmonary disease. Am Rev Respir Dis 1986; 133: 14-20.

    Google Scholar 

  4. Hansen EF, Phanareth K, Laursen LC, Kok-Jensen A, Dirksen A. Reversible and irreversible airflow obstruction as predictor of overall mortality in asthma and chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1999; 159: 1267-1271.

    Google Scholar 

  5. Postma DS, Sluiter HJ. Prognosis of chronic obstructive pulmonary disease: The Dutch experience. Am Rev Respir Dis 1989; 140: S100-S105.

    Google Scholar 

  6. Kanner RE. The relationship between airways responsiveness and chronic airflow limitation. Chest 1984; 86: 54-57.

    Google Scholar 

  7. Renwick D, Connolly M. Impact of obstructive airways disease on quality of life in older adults. Thorax 1996; 51: 520-525.

    Google Scholar 

  8. Jones PW, Bosh TK. Quality of life changes in COPD patients treated with salmeterol. Am J Respir Crit Care Med 1997; 155: 1283-1289.

    Google Scholar 

  9. Bellia V, Pistelli R, Catalano F, et al. Quality control of spirometry in the elderly: The Sa.R.A. Study. Am J Respir Crit Care 2000; 161: 1094-1100.

    Google Scholar 

  10. Antonelli Incalzi R, Bellia V, Catalano F, et al. Evaluation of health outcomes in elderly patients with asthma and COPD by using disease-specific and generic instruments: The Sa.R.A. study. Chest 2001; 120: 734-742.

    Google Scholar 

  11. Jones PW, Quirk FH, Bavestock CM, Littlejohns P. A selfcomplete measure of health status for chronic airflow limitation. Am Rev Respir Dis 1992; 145: 1321-1327.

    Google Scholar 

  12. Mahoney F, Barthel D. Functional evaluation: The Barthel Index. MD State Med J 1965; 14: 61-65.

    Google Scholar 

  13. Guyatt GH, Sullivan MJ, Thompson PJ, et al. The six minute walk: A new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 1985; 132: 919-923.

    Google Scholar 

  14. Folstein M, Folstein S, McHugh P. Mini mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198.

    Google Scholar 

  15. Yesavage J, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: A preliminary report. J Psychiatr Res 1982; 17: 37-49.

    Google Scholar 

  16. Maggi S, Langlois JA, Minicuci N, et al. Sleep complaints in community-dwelling older person: Prevalence, associated factors, and reported causes. J Am Geriatr Soc 1998; 46 (2): 161-168.

    Google Scholar 

  17. Vermeire PA, Pride NB. A 'splitting' look at chronic nonspecific lung disease (CNSLD): Common features but diverse pathogenesis. Eur Respir J 1991; 4: 490-496.

    Google Scholar 

  18. American Thoracic Society. Standardization of spirometry. 1994 Update. Am J Respir Crit Care Med 1995; 152: 1107-1136.

    Google Scholar 

  19. Enright PL, Sherrill DL. Reference equations for the sixminute walk in healthy adults. Am J Respir Crit Care Med 1998; 158: 1384-1387.

    Google Scholar 

  20. Grigoletto F, Zappalà G, Anderson DW, Lebowitz BD. Norms for the Mini-Mental State Examination in a healthy population. Neurology 1999; 53: 315-320.

    Google Scholar 

  21. Morrison DF. Multivariate Statistical Methods. 3rd ed., New York: McGraw-Hill, 1990.

    Google Scholar 

  22. Brown GW. Discriminant analysis. Am J Dis Child 1984; 138: 395-400.

    Google Scholar 

  23. Petty TL, Weinman GG. Building a national strategy for the prevention and management of and research in chronic obstructive pulmonary disease. JAMA 1997; 277: 246-253.

    Google Scholar 

  24. Hajiro T, Nishimura K, Tsukino M, Ikeda A, Oga T, Izumi T. A compariosn of the level of dyspnea vs disease severity in indicating the health-related quality of life of patients with COPD. Chest 1999; 116: 1632-1637.

    Google Scholar 

  25. Agusti AG. Systemic effects of chronic obstructive pulmonary disease. Novartis Found Symp 2001; 234: 242-249.

    Google Scholar 

  26. Engelen MP, Schols AM, Lamers RJ, Wouters EF. Different patterns of chronic tissue wasting among patients with chronic obstructive pulmonary disease. Clin Nutr 1999; 18: 275-280.

    Google Scholar 

  27. Albrecht GL, Devlieger PJ. The disability paradox: High quality of life against all odds. Soc Science Med 1998; 48: 977-988.

    Google Scholar 

  28. Braman SS, Kaemmerlen JT, Davis SM. Asthma in the elderly. A comparison between patients with recently acquired and long-standing disease. Am Rev Respir Dis 1991;143: 336-340.

    Google Scholar 

  29. Griffiths C, Feder G, Wedzicha J, Foster G, Livingstone A, Marlowe GS. Feasibility of spirometry and reversibility testing for the identification of patients with chronic obstructive pulmonary disease on asthma registers in general practice. Respir Med 1999; 93: 903-908.

    Google Scholar 

  30. Meslier N, Racineux JL, Six P, Lockhart A. Diagnostic value of reversibility of chronic airway obstruction to separate asthma from chronic bronchitis: A statistical approach. Eur Respir J 1989; 2: 497-505.

    Google Scholar 

  31. Hudon C, Turcotte H, Laviolette M, Carrier G, Boulet LP. Characteristics of bronchial asthma with incomplete reversibility of airflow obstruction. Ann Allergy Asthma Immunol 1997; 78: 195-202.

    Google Scholar 

  32. Ulrik CS, Backer V. Non reversible airflow obstruction in life-long nonsmokers with moderate to severe asthma. Eur Respir J 1999; 14: 892-896.

    Google Scholar 

  33. Pellegrino R, Rodarte JR, Brusasco V. Assessing the reversibility of airway obstruction. Chest 1998; 14: 1607-1612.

    Google Scholar 

  34. Ciba Guest Symposium. Terminology, definitions and classifications of chronic pulmonary emphysema and related conditions. Thorax 1959; 14: 286-299.

    Google Scholar 

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Correspondence to R.A. Incalzi.

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Incalzi, R., Bellia, V., Maggi, S. et al. Reversible bronchial obstruction and disease-related health status in COPD. Qual Life Res 11, 517–525 (2002). https://doi.org/10.1023/A:1016349530281

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